Effect of Difficult Common Bile Duct Stone on Conversion Rate from Laparoscopic to Open Cholecystectomy
DOI:
https://doi.org/10.31584/jhsmr.20231022Keywords:
common bile duct stone, conversion rate, laparoscopic cholecystectomyAbstract
Objective: This study aimed to evaluate the effect of difficult common bile duct (CBD) stone on conversion rate of Laparoscopic cholecystectomy (LC). In addition, this study evaluated the effect of difficult CBD stone on operative time and complications in LC procedures.
Material and Methods: The medical records at Her Royal Highness Princess Maha Chakri Sirindhorn Medical Center, Srinakharinwirot University; from January 2017 to December 2021, were retrospectively reviewed. We enrolled patients with CBD stone having undergone endoscopic retrograde cholangiopancreatography (ERCP), followed by LC. Difficult CBD stones was defined as: a stone diameter >1.5 cm, biliary stricture, Mirizzi’s syndrome, cystic duct stone or stone that could not be extracted in the first ERCP.
Results: Of the 140 patients, a total of 40.7% were male. The mean age was 60.8 years. From this 30% of patients had difficult CBD stones. The conversion rate was 10%. By univariate analysis, the difficult CBD stone was statistically significantly associated with a predictor of conversion rate (r=0.30, p-value<0.001). The odds ratio was 7.34 (95% confidence interval (CI) 2.15-25.05, p-value=0.001). From the result of LC, operation time (p-value=0.002), overall complications (p-value=0.003) and length of hospital stay (p-value=0.002) were significantly higher in difficult than non-difficult CBD stones.
Conclusion: Difficult CBD stones could increase the conversion rate from laparoscopic to open cholecystectomy, which requires more operation time, has complications and longer length of hospital stay than non-difficult CBD stones in LC procedures. LC after ERCP in this group should be carefully performed by an experienced surgeon.
References
European Association for the study of the Liver (EASL). Electronic address: easloffice@easloffice.eu. EASL Clinical Practice Guidelines on the prevention, diagnosis and treatment of gallstones. J Hepatol 2016;65:146-81. doi: 10.1016/j.jhep.2016.03.005.
Warchałowski Ł, Łuszczki E, Bartosiewicz A, Dereñ K, Warchałowska M, Oleksy Ł, et al. The analysis of risk factors in the conversion from laparoscopic to open cholecystectomy. Int J Environ Res Public Health 2020;17:7571. doi: 10.3390/ijerph17207571.
Hu ASY, Menon R, Gunnarsson R, de Costa A. Risk factors for conversion of laparoscopic cholecystectomy to open surgery -a systematic literature review of 30 studies. Am J Surg 2017;214:920-30. doi: 10.1016/j.amjsurg.2017.07.029.
Overby DW, Apelgren KN, Richardson W, Fanelli R; Society of american gastrointestinal and endoscopic surgeons. SAGES guidelines for the clinical application of laparoscopic biliary tract surgery. Surg Endosc 2010;24:2368-86. doi: 10.1007/s00464-010-1268-7.
ASGE Standards of Practice Committee, Buxbaum JL, Abbas Fehmi SM, Sultan S, Fishman DS, Qumseya BJ, Cortessis VK, et al. ASGE guideline on the role of endoscopy in the evaluation and management of choledocholithiasis. Gastrointest Endosc 2019;89:1075-105.e15. doi: 10.1016/j.gie.2018.10.001.
Ishizaki Y, Miwa K, Yoshimoto J, Sugo H, Kawasaki S. Conversion of elective laparoscopic to open cholecystectomy between 1993 and 2004. Br J Surg 2006;93:987-91. doi: 10.1002/bjs.5406.
Ercan M, Bostanci EB, Teke Z, Karaman K, Dalgic T, Ulas M, et al. Predictive factors for conversion to open surgery in patients undergoing elective laparoscopic cholecystectomy. J Laparoendosc Adv Surg Tech A 2010;20:427-34. doi: 10.1089/lap.2009.0457.
Domínguez LC, Rivera A, Bermúdez C, Herrera W. Analysis of factors for conversion of laparoscopic to open cholecystectomy: a prospective study of 703 patients with acute cholecystitis. Cirugia Espanola 2011;89:300e306.
Reinders JS, Gouma DJ, Heisterkamp J, Tromp E, van Ramshorst B, Boerma D. Laparoscopic cholecystectomy is more difficult after a previous endoscopic retrograde cholangiography. HPB (Oxford). 2013;15:230-4. doi: 10.1111/j.1477-2574.2012.00582.x.
Krishnamohan N, Lo C, Date RS. Predicting the degree of difficulty of laparoscopic cholecystectomy following endoscopic retrograde cholangiopancreatography - subgroup analysis does not improve the prediction. J Minim Access Surg 2019;15: 360–1.
Cinar H, Ozbalci GS, Tarim IA, Karabulut K, Kesicioglu T, Polat AK, et al. Factors affecting the conversion to open surgery during laparoscopic cholecystectomy in patients with cholelithiasis undergoing ERCP due to choledocholithiasis. Ann Ital Chir 2017;88:229-36.
Konsue C, Eurboonyanun C, Ruangwannasak S, Eurboonyanun K, Srisuk T, Satitkarnmanee E, et al. Factors associated with the success rate of endoscopic retrograde cholangiopancreatography with standard technique followed by laparoscopic cholecystectomy in the management of choledocholithiasis: a single-center experience. J Dig Endosc 2020;11:126-33.
Bostanci EB, Ercan M, Ozer I, Teke Z, Parlak E, Akoglu M. Timing of elective laparoscopic cholecystectomy after endoscopic retrograde cholangiopancreaticography with sphincterotomy: a prospective observational study of 308 patients. Langenbecks Arch Surg 2010;395:661-6. doi: 10.1007/s00423-010-0653-y.
Agha R, Abdall-Razak A, Crossley E, Dowlut N, Iosifidis C, Mathew G; STROCSS Group. STROCSS 2019 Guideline: Strengthening the reporting of cohort studies in surgery. Int J Surg 2019;72:156-65. doi: 10.1016/j.ijsu.2019.11.002.
Ödemiş B, Kuzu UB, Öztaş E, Saygılı F, Suna N, Coskun O, et al. Endoscopic management of the difficult bile duct stones: a single tertiary center experience. Gastroenterol Res Pract 2016;8749583. doi: 10.1155/2016/8749583.
Kilciler G, Musabak U, Bagci S, Yesilova Z, Tuzun A, Uygun A, et al. Do the changes in the serum levels of IL-2, IL-4, TNFalpha, and IL-6 reflect the inflammatory activity in the patients with post-ERCP pancreatitis? Clin Dev Immuno 2008;2008:481560. doi: 10.1155/2008/481560.
Zang JF, Zhang C, Gao JY. Endoscopic retrograde cholangiopancreatography and laparoscopic cholecystectomy during the same session: feasibility and safety. World J Gastroenterol 2013;19:6093-7. doi: 10.3748/wjg.v19.i36.6093.
Kenny R, Richardson J, McGlone ER, Reddy M, Khan OA. Laparoscopic common bile duct exploration versus pre or post-operative ERCP for common bile duct stones in patients undergoing cholecystectomy: is there any difference? Int J Surg 2014;12:989-93. doi: 10.1016/j.ijsu.2014.06.013.
de Vries A, Donkervoort SC, van Geloven AA, Pierik EG. Conversion rate of laparoscopic cholecystectomy after endoscopic retrograde cholangiography in the treatment of choledocholithiasis: does the time interval matter? Surg Endosc 2005;19:996-1001. doi: 10.1007/s00464-004-2206-3.
Kostro J, Marek I, Pẹksa R, Łaski D, Hellmann AR, Kobiela J, et al. Cholecystectomy after endoscopic retrograde cholangiopancreatography-effect of time on treatment outcomes. Prz Gastroenterol 2018;13:251-7. doi: 10.5114/pg.2018.78292.
Brüggmann D, Tchartchian G, Wallwiener M, Münstedt K, Tinneberg HR, Hackethal A. Intra-abdominal adhesions: definition, origin, significance in surgical practice, and treatment options. Dtsch Arztebl Int 2010;107:769-75.
Lau H, Lo CY, Patil NG, Yuen WK. Early versus delayed-interval laparoscopic cholecystectomy for acute cholecystitis: a meta-analysis. Surg Endosc 2006;20:82-7.
Abdalkoddus M, Franklyn J, Ibrahim R, Yao L, Zainudin N, Aroori S. Delayed cholecystectomy following endoscopic retrograde cholangio-pancreatography is not associated with worse surgical outcomes. Surg Endosc 2022;36:2987-93. doi: 10.1007/s00464-021-08593-w.
Friis C, Rothman JP, Burcharth J, Rosenberg J. Optimal timing for laparoscopic cholecystectomy after endoscopic retrograde cholangiopancreatography: a systematic review. Scand J Surg 2018;107:99-106. doi: 10.1177/1457496917748224.
Borreca D, Bona a, Bellomo MP, Borasi A, Paolis PD. “Ultra-rapid” sequential treatment in cholecystocholedocholithiasis: alternative same-day approach to laparoendoscopic rendezvous. Updates Surg 2015;67:449–54.
Wild JL, Younus MJ, Torres D, Widom K, Leonard D, Dove J, et al. Same-day combined endoscopic retrograde cholangiopancreatography and cholecystectomy: Achievable and minimizes costs. J Trauma Acute Care Surg 2015;78:503-7. doi: 10.1097/TA.0000000000000552.
Brunt LM, Deziel DJ, Telem DA, Strasberg SM, Aggarwal R, Asbun H, et al. Safe cholecystectomy multi-society practice guideline and state of the art consensus conference on prevention of bile duct injury during cholecystectomy. Ann Surg 2020;272:3–23. doi: 10.1097/SLA. 0000000000003791.
Tullavardhana T. Critical view of safety: a safe method to prevent bile duct injury from laparoscopic cholecystectomy. J Med Health Sci 2015;22:49-57.
de’Angelis N, Catena F, Memeo R, Coccolini F, Martínez-Pérez A, Romeo OM, et al. 2020 WSES guidelines for the detection and management of bile duct injury during cholecystectomy. World J Emerg Surg 2021;16:30. doi: 10.1186/s13017-021-00369-w.
Sgaramella LI, Gurrado A, Pasculli A, de Angelis N, Memeo R, Prete FP, et al. The critical view of safety during laparoscopic cholecystectomy: Strasberg Yes or No? An Italian multicentre study. Surg Endosc 2020. doi: 10.1007/s00464-020-07852-6.
Ding GQ, Cai W, Qin MF. Is intraoperative cholangiography necessary during laparoscopic cholecystectomy for cholelithiasis? World J Gastroenterol 2015;21:2147–51. doi: 10.3748/wjg.v21.i7.2147.
Goldstein SD, Lautz TB. Fluorescent cholangiography during laparoscopic cholecystectomy: shedding new light on biliary anatomy. JAMA Surg 2020;155:978. doi.org/10.1001/jamasurg.2020.3003.
Tao Z, Emuakhagbon VS, Pham T, Augustine MM, Guzzetta A, Huerta S. Outcomes of robotic and laparoscopic cholecystectomy for benign gallbladder disease in Veteran patients. J Robot Surg 2021;15:849-57. doi: 10.1007/s11701-020-01183-3.
Downloads
Published
How to Cite
Issue
Section
License
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
