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Single-stage approach for the management of choledocolithiasis with concomitant cholelithiasis. Implementation of a protocol in a secondary hospital
- Source :
- The surgeon : journal of the Royal Colleges of Surgeons of Edinburgh and Ireland. 17(6)
- Publication Year :
- 2018
-
Abstract
- Background Current evidence shows that single-stage treatment of concomitant choledocholithiasis and cholelithiasis is as effective and safe as two-stage treatment. However, several studies suggest that single-stage approach requires shorter hospitalization time and is more cost-effective than the two-stage approach, even though it requires considerable training. This study aimed to evaluate the implementation of a protocol for managing concomitant choledocholithiasis and cholelithiasis using single-stage treatment. Methods A prospective cohort study of patients diagnosed with cholelithiasis and choledocholithiasis who were treated with the single-stage treatment – transcystic instrumentation, choledocotomy or intraoperative endoscopic retrograde cholangiopancreatography (ERCP) – between September 2010 and June 2017 was assessed. The primary outcomes were complications, hospital stay, operative time and recurrence rate. Results 164 patients were enrolled. 141 (86%) were operated laparoscopically. Preoperatively diagnosed stones were not found by intraoperative imaging or disappeared after “flushing” in 38 patients (23.2%). Surgical approach was transcystic in 45 patients (27.41%), choledochotomy in 74 (45.1%), intraoperative ERCP in 4 (2.4%), and bilioenteric derivation in 3 (1.8%). Mean hospitalization stay was 4.4 days. Mean operative time was 166 min 27 patients (16.5%) had complications and 1 patient was exitus (0.6%). Recurrence rate was 1.2%. Conclusions Single-stage approach is a safe and effective management option for concomitant cholelithiasis and choledocolithiasis. Furthermore, a significant number of common bile duct stones pass spontaneously to duodenum or can benefit from a transcystic approach, with presumable low morbidity and cost-efficiency.
- Subjects :
- Adult
Male
medicine.medical_specialty
Operative Time
030230 surgery
03 medical and health sciences
Young Adult
0302 clinical medicine
Clinical Protocols
medicine
Humans
Derivation
Prospective Studies
Prospective cohort study
Aged
Aged, 80 and over
Cholangiopancreatography, Endoscopic Retrograde
Surgical approach
Common bile duct
Single stage
business.industry
Patient Selection
Length of Stay
Middle Aged
Surgery
Biliary Tract Surgical Procedures
medicine.anatomical_structure
Choledocholithiasis
Treatment Outcome
Concomitant
Duodenum
Operative time
030211 gastroenterology & hepatology
Female
business
Subjects
Details
- ISSN :
- 1479666X
- Volume :
- 17
- Issue :
- 6
- Database :
- OpenAIRE
- Journal :
- The surgeon : journal of the Royal Colleges of Surgeons of Edinburgh and Ireland
- Accession number :
- edsair.doi.dedup.....999f3b2cfd80204f7551cfd504c446c9