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Surgical Endoscopy
Published in: Surgical Endoscopy 12/2011

01-12-2011

Major biliary complications in 2,714 cases of laparoscopic cholecystectomy without intraoperative cholangiography: a multicenter retrospective study

Authors: Mostafa A. Hamad, Ahmad A. Nada, Mohamad Y. Abdel-Atty, Ahmad S. Kawashti

Published in: Surgical Endoscopy | Issue 12/2011

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Abstract

Background

The ongoing debate between routine and selective users of intraoperative cholangiography (IOC) during laparoscopic cholecystectomy (LC) has not yet come to an end. Routine users argue that IOC decreases the rate of biliary complications such as bile duct injury, biliary leak and missed common bile duct (CBD) stones, a claim that selective users do not fully support. On the other hand, a third policy that was adopted by many other centers is performing LC without IOC. In this retrospective study, we are exploring the results of a relatively large multicenter series of LC without IOC regarding major biliary complications.

Methods

We performed a retrospective analysis of LC cases operated by experienced laparoscopic surgeons, without resorting to IOC, in four surgical units of university hospitals in Egypt during a 6-year period (January 2004 through December 2009). Excluded from the study were cases with positive predictors of CBD stones, namely, sonographically detected CBD dilatation and/or CBD stones, elevated bilirubin and/or alkaline phosphatase, persistent biliary pancreatitis, cholangitis, and those who had preoperative magnetic resonance cholangiography.

Results

Of the 2,955 cases of LC reviewed, 241 were excluded, leaving 2,714 cases enrolled in the study. Fifty-five cases (2%) were converted to open surgery. Five cases (0.18%) had major bile duct injuries requiring surgical repair. Postoperative bile leakage was encountered in seven cases (0.26%). Missed CBD stones were reported in six cases (0.22%). There was no perioperative mortality in the present study.

Conclusion

LC can be performed safely without the use of IOC, with acceptable low rates of biliary complications provided that proper detection of patients with silent CBD stones is done and facilities for pre- and postoperative endoscopic retrograde cholangiopancreatography are available.
Literature
1.
Shamiyeh A, Wayand W (2005) Current status of laparoscopic therapy of cholecystolithiasis and common bile duct stones. Dig Dis 23:119–126PubMedCrossRef
2.
Keus F, de Jong JA, Gooszen HG, van Laarhoven CJ (2006) Laparoscopic versus open cholecystectomy for patients with symptomatic cholecystolithiasis. Cochrane Database Syst Rev 18:CD006231
3.
Williams LF Jr, Chapman WC, Bonau RA, McGee EC Jr, Boyd RW, Jacobs JK (1993) Comparison of laparoscopic cholecystectomy with open cholecystectomy in a single center. Am J Surg 165:459–465PubMedCrossRef
4.
Berggren U, Gordh T, Grama D, Haglund U, Rashad J, Arvidsson D (1994) Laparoscopic versus open cholecystectomy: hospitalization, sick leave, analgesia, and trauma responses. Br J Surg 81:1362–1365PubMedCrossRef
5.
6.
Traverso LW (2006) Intraoperative cholangiography lowers the risk of bile duct injury during cholecystectomy. Surg Endosc 20:1659–1661PubMedCrossRef
7.
Waage A, Nilsson M (2006) Iatrogenic bile duct injury: a population-based study of 152 776 cholecystectomies in the Swedish Inpatient Registry. Arch Surg 141:1207–1213PubMedCrossRef
8.
Edye M, Dalvi A, Canin-Endres J, Baskin-Bey E, Salky B (2002) Intraoperative cholangiography is still indicated after preoperative endoscopic cholangiography for gallstone disease. Surg Endosc 16:799–802PubMedCrossRef
9.
Pierce RA, Jonnalagadda S, Spitler JA, Tessier DJ, Liaw JM, Lall SC, Melman LM, Frisella MM, Todt LM, Brunt LM, Halpin VJ, Eagon JC, Edmundowicz SA, Matthews BD (2008) Incidence of residual choledocholithiasis detected by intraoperative cholangiography at the time of laparoscopic cholecystectomy in patients having undergone preoperative ERCP. Surg Endosc 22:2365–2372PubMedCrossRef
10.
Flum DR, Dellinger EP, Cheadle A, Chan L, Koepsell T (2003) Intraoperative cholangiography and risk of common bile duct injury during cholecystectomy. JAMA 289:1639–1644PubMedCrossRef
11.
Nickkholgh A, Soltaniyekta S, Kalbasi H (2006) Routine versus selective intraoperative cholangiography during laparoscopic cholecystectomy: a survey of 2,130 patients undergoing laparoscopic cholecystectomy. Surg Endosc 20:868–874PubMedCrossRef
12.
Phillips EH (1993) Routine versus selective intraoperative cholangiography. Am J Surg 165:505–507PubMedCrossRef
13.
Carlson MA, Ludwig KA, Frantzides CT, Cattey RP, Henry LG, Walker AP, Schulte WJ, Wilson SD (1993) Routine or selective intraoperative cholangiography in laparoscopic cholecystectomy. J Laparoendosc Surg 3:27–33PubMedCrossRef
14.
Soper NJ, Dunnegan DL (1992) Routine versus selective intra-operative cholangiography during laparoscopic cholecystectomy. World J Surg 16:1133–1140PubMedCrossRef
15.
Zacharakis E, Angelopoulos S, Kanellos D, Pramateftakis MG, Sapidis N, Stamatopoulos H, Kanellos I, Tsalis K, Betsis D (2007) Laparoscopic cholecystectomy without intraoperative cholangiography. J Laparoendosc Adv Surg Tech A 17:620–625PubMedCrossRef
16.
Fogli L, Boschi S, Patrizi P, Berta RD, Al Sahlani U, Capizzi D, Capizzi FD (2009) Laparoscopic cholecystectomy without intraoperative cholangiography: audit of long-term results. J Laparoendosc Adv Surg Tech A 19:191–193PubMedCrossRef
17.
Mir IS, Mohsin M, Kirmani O, Majid T, Wani K, Hassan MU, Naqshbandi J, Maqbool M (2007) Is intra-operative cholangiography necessary during laparoscopic cholecystectomy? A multicentre rural experience from a developing world country. World J Gastroenterol 13:4493–4497PubMed
18.
Reynolds W Jr (2001) The first laparoscopic cholecystectomy. JSLS 5:89–94PubMed
19.
MacFadyen BV (2006) Intraoperative cholangiography: past, present, and future. Surg Endosc 20(Suppl):S436–S440PubMedCrossRef
20.
Demling L, Classen M, Koch H (1972) Enteroscopy with retrograde demonstration of the pancreatic and biliary ducts. Dtsch Z Verdau Stoffwechselk 32:149–152
21.
IH N (2002) NIH state-of-the-science statement on endoscopic retrograde cholangiopancreatography (ERCP) for diagnosis and therapy. NIH Consens State Sci Statements 19:1–26
22.
Flum DR, Koepsell T, Heagerty P, Sinanan M, Dellinger EP (2001) Common bile duct injury during laparoscopic cholecystectomy and the use of intraoperative cholangiography: adverse outcome or preventable error? Arch Surg 136:1287–1292PubMedCrossRef
23.
Ludwig K, Bernhardt J, Steffen H, Lorenz D (2002) Contribution of intraoperative cholangiography to incidence and outcome of common bile duct injuries during laparoscopic cholecystectomy. Surg Endosc 16:1098–1104PubMedCrossRef
24.
Flum DR, Flowers C, Veenstra DL (2003) A cost-effectiveness analysis of intraoperative cholangiography in the prevention of bile duct injury during laparoscopic cholecystectomy. J Am Coll Surg 196:385–393PubMedCrossRef
25.
Massarweh NN, Devlin A, Elrod JA, Symons RG, Flum DR (2008) Surgeon knowledge, behavior, and opinions regarding intraoperative cholangiography. J Am Coll Surg 207:821–830PubMedCrossRef
26.
Debru E, Dawson A, Leibman S, Richardson M, Glen L, Hollinshead J, Falk GL (2005) Does routine intraoperative cholangiography prevent bile duct transection? Surg Endosc 19:589–593PubMedCrossRef
27.
Metcalfe MS, Ong T, Bruening MH, Iswariah H, Wemyss-Holden SA, Maddern GJ (2004) Is laparoscopic intraoperative cholangiogram a matter of routine? Am J Surg 187:475–481PubMedCrossRef
28.
Livingston EH, Miller JA, Coan B, Rege RV (2007) Costs and utilization of intraoperative cholangiography. J Gastrointest Surg 11:1162–1167PubMedCrossRef
29.
Rosseland AR, Glomsaker TB (2000) Asymptomatic common bile duct stones. Eur J Gastroenterol Hepatol 12:1171–1173PubMedCrossRef
30.
Hanif F, Ahmed Z, Samie MA, Nassar AH (2010) Laparoscopic transcystic bile duct exploration: the treatment of first choice for common bile duct stones. Surg Endosc 24:1552–1556PubMedCrossRef
31.
Rogers SJ, Cello JP, Horn JK, Siperstein AE, Schecter WP, Campbell AR, Mackersie RC, Rodas A, Kreuwel HT, Harris HW (2010) Prospective randomized trial of LC+LCBDE vs ERCP/S+LC for common bile duct stone disease. Arch Surg 145:28–33PubMedCrossRef
32.
Barkay O, Khashab M, Al-Haddad M, Fogel EL (2009) Minimizing complications in pancreaticobiliary endoscopy. Curr Gastroenterol Rep 11:134–141PubMedCrossRef
33.
Balandraud P, Biance N, Peycru T, Tardat E, Bonnet PM, Cazeres C, Hardwigsen J (2008) Fortuitous discovery of common bile duct stones: results of a conservative strategy. Gastroenterol Clin Biol 32:408–412PubMedCrossRef
34.
Ammori BJ, Birbas K, Davides D, Vezakis A, Larvin M, McMahon MJ (2000) Routine vs “on demand” postoperative ERCP for small bile duct calculi detected at intraoperative cholangiography. Clinical evaluation and cost analysis. Surg Endosc 14:1123–1126PubMedCrossRef
35.
Spinn MP, Wolf DS, Verma D, Lukens FJ (2010) Prediction of which patients with an abnormal intraoperative cholangiogram will have a confirmed stone at ERCP. Dig Dis Sci 55:1479–1484PubMedCrossRef
36.
Varadarajulu S, Eloubeidi MA, Wilcox CM, Hawes RH, Cotton PB (2006) Do all patients with abnormal intraoperative cholangiogram merit endoscopic retrograde cholangiopancreatography? Surg Endosc 20:801–805PubMedCrossRef
37.
Targarona EM, Bendahan GE (2004) Management of common bile duct stones: controversies and future perspectives. HPB (Oxford) 6:140–143
38.
Taylor OM, Sedman PC, Jones BM, Royston CM, Arulampalam T, Wellwood J (1997) Laparoscopic cholecystectomy without operative cholangiogram: 2038 cases over a 5-year period in two district general hospitals. Ann R Coll Surg Engl 79:376–380PubMed
39.
Lorimer JW (2004) Results of cholecystectomy without intraoperative cholangiography. Can J Surg 47:343–346PubMed
40.
Romano F, Franciosi CM, Caprotti R, De Fina S, Lomazzi A, Colombo G, Visintini G, Uggeri F (2002) Preoperative selective endoscopic retrograde cholangiopancreatography and laparoscopic cholecystectomy without cholangiography. Surg Laparosc Endosc Percutan Tech 12:408–411PubMedCrossRef
41.
Coppola R, Riccioni ME, Ciletti S, Cosentino L, Ripetti V, Magistrelli P, Picciocchi A (2001) Selective use of endoscopic retrograde cholangiopancreatography to facilitate laparoscopic cholecystectomy without cholangiography. A review of 1139 consecutive cases. Surg Endosc 15:1213–1216PubMedCrossRef
42.
McFarlane ME, Thomas CA, McCartney T, Bhoorasingh P, Smith G, Lodenquai P, Mitchell DI (2005) Selective operative cholangiography in the performance of laparoscopic cholecystectomy. Int J Clin Pract 59:1301–1303PubMedCrossRef
43.
Lepner U, Grünthal V (2005) Intraoperative cholangiography can be safely omitted during laparoscopic cholecystectomy: a prospective study of 413 consecutive patients. Scand J Surg 94:197–200PubMed
44.
Katz D, Nikfarjam M, Sfakiotaki A, Christophi C (2004) Selective endoscopic cholangiography for the detection of common bile duct stones in patients with cholelithiasis. Endoscopy 36:1045–1049PubMedCrossRef
45.
Borjeson J, Liu SK, Jones S, Matolo NM (2000) Selective intraoperative cholangiography during laparoscopic cholecystectomy: how selective? Am Surg 66:616–618PubMed
46.
Nassar AH, El Shallaly G, Hamouda AH (2009) Optimising laparoscopic cholangiography time using a simple cannulation technique. Surg Endosc 23:513–517PubMedCrossRef
Metadata
Title
Major biliary complications in 2,714 cases of laparoscopic cholecystectomy without intraoperative cholangiography: a multicenter retrospective study
Authors
Mostafa A. Hamad
Ahmad A. Nada
Mohamad Y. Abdel-Atty
Ahmad S. Kawashti
Publication date
01-12-2011
Publisher
Springer-Verlag
Published in
Surgical Endoscopy / Issue 12/2011
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-011-1780-4

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