• Skip to primary navigation
  • Skip to main content
  • Skip to primary sidebar
  • Skip to footer

SAGES

Reimagining surgical care for a healthier world

  • Home
    • COVID-19 Annoucements
    • Search
    • SAGES Home
    • SAGES Foundation Home
  • About
    • Who is SAGES?
    • SAGES Mission Statement
    • Strategic Plan, 2020-2023
    • Committees
      • Descriptions and Video Updates
      • Request to Join a SAGES Committee
      • SAGES Board of Governors
      • Officers and Representatives of the Society
      • Committee Chairs and Co-Chairs
      • Full Committee Rosters
      • SAGES Past Presidents
    • Donate to the SAGES Foundation
    • Awards
      • George Berci Award
      • Pioneer in Surgical Endoscopy
      • Excellence In Clinical Care
      • International Ambassador
      • IRCAD Visiting Fellowship
      • Distinguished Service
      • Early Career Researcher
      • Researcher in Training
      • Jeff Ponsky Master Educator
      • Excellence in Medical Leadership
      • Barbara Berci Memorial Award
      • Brandeis Scholarship
      • Advocacy Summit
      • RAFT Annual Meeting Abstract Contest and Awards
  • Meetings
    • COVID-19 Announcements
    • SAGES 2020 Meeting Information
    • 2021 Scientific Session Call For Abstracts
    • 2021 Emerging Technology Session Call For Abstracts
    • 2018 Prevent BDI Consensus Conference
    • CME Claim Form
    • Industry
      • Advertising Opportunities
      • Exhibit Opportunities
      • Sponsorship Opportunities
    • Future Meetings
    • Past Meetings
      • Leadership Development and Health Policy Conference Videos
      • SAGES Quality Summit Meeting
      • SAGES 2019
      • SAGES 2018
      • SAGES 2017
      • SAGES 2016
      • SAGES 2015
      • SAGES 2014
      • SAGES 2013
    • Related Meetings Calendar
  • Membership
    • Membership Benefits
    • Membership Applications
      • Active Membership
      • Affiliate Membership
      • Associate Active Membership
      • Candidate Membership
      • International Membership
      • Medical Student Membership
    • Member News
      • Member Spotlight
      • Give the Gift of SAGES Membership
  • Patients
    • Healthy Sooner – Patient Information for Minimally Invasive Surgery
    • Patient Information Brochures
    • Choosing Wisely – An Initiative of the ABIM Foundation
    • All in the Recovery: Colorectal Cancer Alliance
    • Find a SAGES Member
  • Publications
    • COVID-19 Annoucements
    • SAGES Clinical / Practice / Training Guidelines, Statements, and Standards of Practice
    • Patient Information Brochures
    • TAVAC – Technology and Value Assessments
    • Surgical Endoscopy and Other Journal Information
    • SAGES Manuals
    • SCOPE – The SAGES Newsletter
    • Troubleshooting Guides
  • Education
    • SAGES.TV Video Library
    • Virtual Hernia Clinic
    • The SAGES Safe Cholecystectomy Program
    • The Safe Cholecystectomy Didactic Modules
    • Masters Program
      • SAGES Facebook Program Collaboratives
      • Acute Care Surgery
      • Bariatric
      • Biliary
      • Colorectal
      • Flexible Endoscopy (upper or lower)
      • Foregut
      • Hernia
      • Robotics
    • Educational Opportunities
    • The SAGES HPB/Solid Organ Program
    • Courses for Residents
      • Advanced Courses
      • Basic Courses
    • Endorsed Courses
    • SAGES Robotics Fellows Courses
    • MIS Fellows Course
    • Facebook Livestreams
    • Free Educational Webinars For Residents
    • SMART Enhanced Recovery Program
    • SAGES Quality Initiative
    • SAGES OR SAFETY Video
    • SAGES at Cine-Med
      • SAGES Top 21 MIS Procedures
      • SAGES Pearls
      • SAGES Flexible Endoscopy 101
      • SAGES Tips & Tricks of the Top 21
  • Opportunities
    • SAGES Research Opportunities
    • SAGES Endorsed Courses
    • Fundamentals of Laparoscopic Surgery
    • Fundamentals of Endoscopic Surgery
    • Fundamental Use of Surgical Energy
    • Job Board
    • SAGES Go Global: Global Affairs and Humanitarian Efforts
    • Fellowship Certification
  • Search
    • COVID-19 Announcements
    • Search All SAGES Content
    • Search SAGES Guidelines
    • Search the Video Library
    • Search the Image Library
    • Search the Abstracts Archive
  • Blog
    • All Blog Posts
    • COVID-19
    • Notes from the Battlefield
    • A (Positive) Way Forward
    • President Posts
  • Log In

Laparoscopic Trans-Cystic Exploration for Single-Stage Management of Common Duct Stones and Acute Cholecystitis

Massimo Chiarugi, MD FACS, Christian Galatioto, MD, Piero Lippolis, MD, Luigi Decanini, MD, Adolfo Puglisi, MD, Chiara Bagnato, MD, Sonia Panicucci, MD, Marco Pelosini, MD, Pietro Iacconi, MD, Massimo Seccia, MD. Department of Surgery, University of Pisa, Pisa, Italy

INTRODUCTION Common bile duct (CBD) stones are found in near 10% of patients undergoing elective laparoscopic surgery for symptomatic gallstone disease. For these patients laparoscopic trans-cystic exploration of the common duct (LTCE) with basket catheters has proved to be a safe and effective method to obtain CBD clearance. The occurrence of CBD stones ranges from 10 to 20% in patients presenting with acute cholecystitis (AC) but in this setting little is known about the feasibility and the effectiveness of LTCE as part of a single-stage laparoscopic procedure.

METHODS AND PROCEDURES We report the results of a prospective study based on a “laparoscopy first” policy for patients with gallstone disease and CBD stones. The study, started in 2003, includes n=201 subjects (n=104 females, n= 97 males) with a mean age of 65 yrs (range 23-100). N=104 patients underwent elective laparoscopic surgery (group A) whereas n=97 were admitted on a emergency basis for AC and had urgent laparoscopic surgery within 72 hours from the admission (group B). All patients had intra-operative cholangiograms confirming the diagnosis of CBD stones. LTCE, when not contra-indicated, was carried-out by using basket-wired catheters. Groups did not differ significantly for BMI, previous abdominal surgery and clinical evidence of obstructive jaundice at the time of surgery. Group B patients however were significantly elder (means, 68.4 vs. 62.1 yrs; p=.0045), had a higher proportion of females (56 vs. 41%; p=.00345) and included more patients in the ASA III and IV classes of risk (39 vs. 21%; p=.0006). Accomplishment of CBD clearance, operating time, conversion rate, overall morbidity and mortality, postoperative hospital stay, readmission rate and occurrence of residual CBD stones were the main outcome measures. Comparisons were made on intention-to-treat basis by using a statistical software.

RESULTS Clearance of CBD was obtained in 84% of patients of group A and in 80% of patients of group B (p=ns). For those patients in which LTCE failed (n=36; 18%) alternative procedures included laparoscopic choledochotomy and ERCP, but in n=16 a laparotomy was eventually required. Time spent in the theatre was significantly longer for group B patients (means, 175 vs. 141 minutes; p=.0003). There were no significant differences for postoperative hospital stay ( means, group A 4.9 vs. group B 5.2 days), readmission rate (group A 3.7 vs. group B 3.7%) and evidence of residual CBD stones (group A 2.8 vs. group B 3.1%). Need to convert and morbidity occurred more frequently in group B (11.7 vs. 4.6% and 28.7 vs. 16.8%, respectively) but differences were not significant. In group A, one patient died from MOFS.

CONCLUSIONS Patients presenting with CBD stones synchronous to AC may benefit from LTCE in a single-stage laparoscopic procedure. LTCE has proved to be a simple technique with a high yield of CBD clearance also in the acute setting. Courses are comparable to those observed for the same procedure in elective surgery despite the fact that acute patients are more at risk for drawbacks.


Session: SS18
Program Number: S105

Post Views: 72

Share this:

  • Twitter
  • Facebook
  • LinkedIn
  • Pinterest
  • WhatsApp
  • Reddit

Related

« Return to SAGES 2011 abstract archive

Our Mission

Innovate, educate and collaborate to improve patient care.

Recently, on SAGES…

Free SAGES Webinar: Lessons from COVID on Living and Thriving as Surgeons

SAGES recognizes that the COVID-19 pandemic has had a big impact on surgical practice and in surgeon wellness. SAGES’ Reimagining the Practice of Surgery Taskforce will present “Finding the Opportunities: Lessons from COVID and How We Live and Thrive as Surgeons”  to look at ways in which innovative leadership at various levels may help transform […]

Daniel Herron, MD

An opportunity to slow down and appreciate the small joys in life

Dan Herron, MD shares insights with Dana Telem, MD on lessons learned from COVID-19 Fear, anxiety and uncertainty has dominated the first half of 2020. Never before have we, as healthcare providers, been asked to do so much with so little—whether it’s resources like personal protective equipment, dusting off skills related to critical care, or […]

covid testing stock

Notes from the Battlefield – May 14, 2020

Coronavirus Global Surgical Collaborative (CVGSC)* An initiative sponsored by SAGES in collaboration with EAES, AEC, KSELS, and ELSA A group of surgical leaders from affected countries have joined to discuss what they are learning during this Covid-19 Global crisis. The following is a brief summary of what they feel may be useful information to disseminate to the surgical […]

Contact SAGES

Society of American Gastrointestinal and Endoscopic Surgeons
11300 W. Olympic Blvd Suite 600
Los Angeles, CA 90064 USA
webmaster@sages.org
Tel: (310) 437-0544

Find Us Around the Web!

  • Facebook
  • Twitter
  • YouTube

Newsletter Subscription

  • This field is for validation purposes and should be left unchanged.

Important Links

SAGES 2020 Meeting Information

Healthy Sooner: Patient Information

SAGES Guidelines, Statements, & Standards of Practice

SAGES Manuals

 

  • taTME Study Info
  • Foundation
  • SAGES.TV
  • MyCME
  • Educational Activities

[footer_backtotop] · Log in

Copyright © 2021 Society of American Gastrointestinal and Endoscopic Surgeons · Legal
· Managed by BSC Management, Inc