Korean J Hepatobiliary Pancreat Surg.  2016 May;20(2):53-60. 10.14701/kjhbps.2016.20.2.53.

Safe laparoscopic clearance of the common bile duct in emergently admitted patients with choledocholithiasis and cholangitis

• Atstupens
• Plaudis H
• Fokins V
• Mukans M
• Pupelis G

• KMID: 2243015
• DOI: http://doi.org/10.14701/kjhbps.2016.20.2.53

Abstract

BACKGROUNDS/AIMS
Laparoscopic treatment of patients with choledocholithiasis and cholangitis is challenging due to mandatory recovery of the biliary drainage and clearance of the common bile duct (CBD). The aim of our study was to assess postoperative course of cholangitis and biliary sepsis after laparoscopic clearance of the CBD in emergently admitted patients with choledocholithiasis and cholangitis.
METHODS
Emergently admitted patients who underwent laparoscopic clearance of the CBD were included prospectively and stratified in 2 groups i.e., cholangitis positive (CH+) or negative (CH-) group. Patient demographics, comorbidities, preoperative imaging data, inflammatory response, surgical intervention, complication rate and outcomes were compared between groups.
RESULTS
Ninety-nine of a total 320 patients underwent laparoscopic clearance of the CBD, of which, 60 belonged to the acute cholangitis group (CH+) and 39 to the cholangitis negative group (CH-). Interventions were done on average 4 days after admission, operation duration was 95-105 min, and the conversion rate was 3-7% without differences in the groups. Preoperative inflammatory response was markedly higher in the CH+ group. Inflammation signs on intraoperative choledochoscopy were more evident in patients with cholangitis. Postoperative inflammatory response did not differ between the groups. The overall complication rate was 8.3% and 5.1%, respectively. Laparoscopic clearance of the CBD resulted in 1 lethal case (CH+ group), resulting in 1% mortality rate and a similar 12-month readmission rate.
CONCLUSIONS
Single-stage laparoscopic intraoperative US and choledochoscopy-assisted clearance of the CBD is feasible in emergently admitted patients with choledocholithiasis and cholangitis.

Keyword

Choledocholithiasis; Laparoscopic surgery; Cholangitis; Ultrasound; Intraoperative; Choledochoscopy

MeSH Terms

Cholangitis*
Choledocholithiasis*
Common Bile Duct*
Comorbidity
Demography
Drainage
Humans
Inflammation
Laparoscopy
Mortality
Prospective Studies
Sepsis
Ultrasonography

Figure

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  Fig. 1 Study population (US, ultrasonoscopy; CBD, common bile duct; CH, acute cholangitis).

• 

  Fig. 2 Dynamics of C-reactive protein (CH, acute cholangitis).

• 

  Fig. 3 Dynamics of white blood cell count (CH, acute cholangitis).

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