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Surgical Endoscopy

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01-03-2024

Risk factors analyses associated with postoperative infection in choledochoscopy for intrahepatic bile duct stones (IHDs): a single-center retrospective study in real-world setting

Authors: Yangyang Ou, Jianjun Li, Chunfeng Liang, Chongyuan Hu, Ming Yao, Yubin Huang, Xiaoyong Cai, Yihe Yan

Published in: Surgical Endoscopy | Issue 4/2024

Abstract

Background

Choledochoscopy is a highly effective approach for managing intrahepatic bile duct stones (IHDs). However, postoperative infection is a common complication that significantly impacts treatment outcomes. Despite its clinical relevance, the risk factors associated with this procedure remain largely unexplored.

Methods

This study focused on a consecutive cohort of patients who underwent choledochoscopy for IHDs at our institution between January 2016 and December 2022. The primary objective was to analyze the relationship between various clinical factors and postoperative infection, and to compare the postoperative infection of different choledochoscopic procedures.

Results

The study cohort consisted of 126 patients, with 60 individuals (47.6%) experiencing postoperative infection. Notably, preoperative biliary obstruction (odds ratio [OR] 1.861; 95% confidence interval [CI] 1.314–8.699; p = 0.010) and operation time (OR 4.414; 95% CI 1.635–12.376; p = 0.004) were identified as risk factors for postoperative infection. Additionally, biliary tract infections (60.00%) were primarily responsible for postoperative infection, with Escherichia coli (47.22%) being the predominant bacterial strain identified in bile cultures. Furthermore, biliary tract obstruction (OR 4.563; 95% CI 1.554–13.401; p = 0.006) and body mass index (BMI) (OR 1.186; 95% CI 1.015–1.386; p = 0.031) were determined to be independent risk factors for postoperative biliary tract infection.

Conclusions

The occurrence of postoperative infection in patients undergoing choledochoscopy was primarily associated with the duration of the operation and the presence of preoperative biliary obstruction.

Graphical abstract

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Fujita N, Yasuda I, Endo I, Isayama H, Iwashita T, Ueki T, Uemura K, Umezawa A, Katanuma A, Katayose Y, Suzuki Y, Shoda J, Tsuyuguchi T, Wakai T, Inui K, Unno M, Takeyama Y, Itoi T, Koike K, Mochida S (2023) Evidence-based clinical practice guidelines for cholelithiasis 2021. J Gastroenterol 58:801–833PubMedPubMedCentralCrossRef

Thuluvath AJ, Ahn JC, Rattan P, Kurdi AT, Peeraphatdit TB, Kamath MJ, Lennon RJ, Poterucha JJ, Petersen BT, Kamath PS (2021) Evaluation of Charcot triad, Reynolds pentad, and Tokyo Guidelines for diagnosis of cholangitis secondary to choledocholithiasis across patient age groups. Mayo Clin Proc Innov Qual Outcomes 5:377–387PubMedPubMedCentralCrossRef

Peng JX, Wang LZ, Diao JF, Tan ZJ, Zhong XS, Zhen ZP, Chen GH, He JM (2018) Major hepatectomy for primary hepatolithiasis: a comparative study of laparoscopic versus open treatment. Surg Endosc 32:4271–4276PubMedPubMedCentralCrossRef

Doganay M, Yuksek YN, Daglar G, Gozalan U, Tutuncu T, Kama NA (2010) Clinical determinants of suppurative cholangitis in malignant biliary tract obstruction. Bratisl Lek Listy 111:336–339PubMed

Sun H, Warren J, Yip J, Ji Y, Hao S, Han W, Ding Y (2022) Factors influencing gallstone formation: a review of the literature. Biomolecules 12:550PubMedPubMedCentralCrossRef

Wang W, Yang C, Wang J, Chen W, Wang J (2023) Hepatolithiasis classification based on anatomical hepatectomy. J Gastrointest Surg 27:914–925PubMedCrossRef

Lorio E, Patel P, Rosenkranz L, Patel S, Sayana H (2020) Management of Hepatolithiasis: review of the literature. Curr Gastroenterol Rep 22:30PubMedCrossRef

Sakpal SV, Babel N, Chamberlain RS (2009) Surgical management of hepatolithiasis. HPB (Oxford) 11:194–202PubMedCrossRef

Dilek ON, Atasever A, Acar N, Karasu Ş, Özlem Gür E, Özşay O, Çamyar H, Dilek FH (2020) Hepatolithiasis: clinical series, review and current management strategy. Turk J Surg 36:382–392PubMedPubMedCentralCrossRef

10.

Buxbaum JL, Abbas Fehmi SM, Sultan S, Fishman DS, Qumseya BJ, Cortessis VK, Schilperoort H, Kysh L, Matsuoka L, Yachimski P, Agrawal D, Gurudu SR, Jamil LH, Jue TL, Khashab MA, Law JK, Lee JK, Naveed M, Sawhney MS, Thosani N, Yang J, Wani SB (2019) ASGE guideline on the role of endoscopy in the evaluation and management of choledocholithiasis. Gastrointest Endosc 89:1075–105.e15PubMedPubMedCentralCrossRef

11.

Liu X, Min X, Ma Z, He X, Du Z (2018) Laparoscopic hepatectomy produces better outcomes for hepatolithiasis than open hepatectomy: an updated systematic review and meta-analysis. Int J Surg (Lond, Engl) 51:151–163CrossRef

12.

Ukhanov AP, Zakharov DV, Zhilin SA, Bolshakov SV, Muminov KD, Aselderov YA (2023) Modern minimally invasive technologies for the treatment of cholelithiasis. Khirurgiia 3:33–40

13.

Disci E, Atamanalp SS, Ozogul B, Yildirgan MI (2016) The role of choledochoscopy in hepatopancreatobiliary diseases. Eurasian J Med 48:29–32PubMedPubMedCentralCrossRef

14.

Zhang JF, Du ZQ, Lu Q, Liu XM, Lv Y, Zhang XF (2015) Risk factors associated with residual stones in common bile duct via T tube cholangiography after common bile duct exploration. Medicine 94:e1043PubMedPubMedCentralCrossRef

15.

Tan HL, Koh YX, Lye WK, Lee SY, Goh BKP, Tan SS, Chiow AKH, Chan CY (2018) Surgical management decreases disease recurrence risk in recurrent pyogenic cholangitis. ANZ J Surg 88:E659–E663PubMedCrossRef

16.

Cheon YK, Cho YD, Moon JH, Lee JS, Shim CS (2009) Evaluation of long-term results and recurrent factors after operative and nonoperative treatment for hepatolithiasis. Surgery 146:843–853PubMedCrossRef

17.

Wang H, Ou Y, Ou J, Jian Z (2019) Complication analysis with percutaneous postoperative choledochoscopy in 826 patients: a single-center study. J Laparoendosc Adv Surg Tech A 29:995–999PubMedCrossRef

18.

Xia H, Zhang H, Xin X, Liang B, Yang T, Liu Y, Wang J, Meng X (2023) Surgical management of recurrence of primary intrahepatic bile duct stones. Can J Gastroenterol Hepatol 2023:5158580PubMedPubMedCentralCrossRef

19.

Jin S, Fu Q, Wuyun G, Wuyun T (2013) Management of post-hepatectomy complications. World J Gastroenterol 19:7983–7991PubMedPubMedCentralCrossRef

20.

Thosani N, Zubarik RS, Kochar R, Kothari S, Sardana N, Nguyen T, Banerjee S (2016) Prospective evaluation of bacteremia rates and infectious complications among patients undergoing single-operator choledochoscopy during ERCP. Endoscopy 48:424–431PubMedCrossRef

21.

Yoon YS, Han HS, Shin SH, Cho JY, Min SK, Lee HK (2009) Laparoscopic treatment for intrahepatic duct stones in the era of laparoscopy: laparoscopic intrahepatic duct exploration and laparoscopic hepatectomy. Ann Surg 249:286–291PubMedCrossRef

22.

Qin J, He Y, Ma L, Duan J, Duan R, Liu R, Zhou J, Yang N, Li Y, Xiong Y, Li H, Zeng X, Li C, Li X (2023) Efficacy of 3D-printed assisted percutaneous transhepatic one-step biliary fistulation combined with rigid choledochoscopy for intrahepatic bile duct stones. Dig Liver Dis 55(12):1699–1704PubMedCrossRef

23.

Zhuo H, Chen Z, Lin R, Yang S, Zhuang H, He C, Liu X (2020) Percutaneous transhepatic choledochoscopic lithotomy (PTCSL) is effective for the treatment of intrahepatic and extrahepatic choledocholithiasis. Surg Laparosc Endosc Percutan Tech 31:326–330PubMedCrossRef

24.

Evans L, Rhodes A, Alhazzani W, Antonelli M, Coopersmith CM, French C, Machado FR, McIntyre L, Ostermann M, Prescott HC, Schorr C, Simpson S, Wiersinga WJ, Alshamsi F, Angus DC, Arabi Y, Azevedo L, Beale R, Beilman G, Belley-Cote E, Burry L, Cecconi M, Centofanti J, Coz Yataco A, De Waele J, Dellinger RP, Doi K, Du B, Estenssoro E, Ferrer R, Gomersall C, Hodgson C, Møller MH, Iwashyna T, Jacob S, Kleinpell R, Klompas M, Koh Y, Kumar A, Kwizera A, Lobo S, Masur H, McGloughlin S, Mehta S, Mehta Y, Mer M, Nunnally M, Oczkowski S, Osborn T, Papathanassoglou E, Perner A, Puskarich M, Roberts J, Schweickert W, Seckel M, Sevransky J, Sprung CL, Welte T, Zimmerman J, Levy M (2021) Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Med 47:1181–1247PubMedPubMedCentralCrossRef

25.

Yokoe M, Hata J, Takada T, Strasberg SM, Asbun HJ, Wakabayashi G, Kozaka K, Endo I, Deziel DJ, Miura F, Okamoto K, Hwang TL, Huang WS, Ker CG, Chen MF, Han HS, Yoon YS, Choi IS, Yoon DS, Noguchi Y, Shikata S, Ukai T, Higuchi R, Gabata T, Mori Y, Iwashita Y, Hibi T, Jagannath P, Jonas E, Liau KH, Dervenis C, Gouma DJ, Cherqui D, Belli G, Garden OJ, Giménez ME, de Santibañes E, Suzuki K, Umezawa A, Supe AN, Pitt HA, Singh H, Chan ACW, Lau WY, Teoh AYB, Honda G, Sugioka A, Asai K, Gomi H, Itoi T, Kiriyama S, Yoshida M, Mayumi T, Matsumura N, Tokumura H, Kitano S, Hirata K, Inui K, Sumiyama Y, Yamamoto M (2018) Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholecystitis (with videos). J Hepatob Pancreat Sci 25:41–54CrossRef

26.

An Z, Braseth AL, Sahar N (2021) Acute cholangitis: causes, diagnosis, and management. Gastroenterol Clin North Am 50:403–414PubMedCrossRef

27.

Miura F, Okamoto K, Takada T, Strasberg SM, Asbun HJ, Pitt HA, Gomi H, Solomkin JS, Schlossberg D, Han HS, Kim MH, Hwang TL, Chen MF, Huang WS, Kiriyama S, Itoi T, Garden OJ, Liau KH, Horiguchi A, Liu KH, Su CH, Gouma DJ, Belli G, Dervenis C, Jagannath P, Chan ACW, Lau WY, Endo I, Suzuki K, Yoon YS, de Santibañes E, Giménez ME, Jonas E, Singh H, Honda G, Asai K, Mori Y, Wada K, Higuchi R, Watanabe M, Rikiyama T, Sata N, Kano N, Umezawa A, Mukai S, Tokumura H, Hata J, Kozaka K, Iwashita Y, Hibi T, Yokoe M, Kimura T, Kitano S, Inomata M, Hirata K, Sumiyama Y, Inui K, Yamamoto M (2018) Tokyo Guidelines 2018: initial management of acute biliary infection and flowchart for acute cholangitis. J Hepatob Pancreat Sci 25:31–40CrossRef

28.

Troncone E, Mossa M, De Vico P, Monteleone G, Del Vecchio BG (2022) Difficult biliary stones: a comprehensive review of new and old lithotripsy techniques. Medicina (Kaunas) 58:120PubMedCrossRef

29.

Lin W, Chen M, Li B, Wang W, Li S, Lyu G (2023) Intraoperative ultrasound-guided percutaneous hepatocholangiostomy applied in the cholangioscopic lithotripsy for hepatolithiasis and choledocholithiasis. Surg Endosc 37:486–493PubMedCrossRef

30.

Chen Z, Hua Z, Lin R, Zhuang H, Liu X (2022) A two-step method for percutaneous transhepatic choledochoscopic lithotomy. J Visual Exp 187:e63206

31.

Tao H, Wang P, Sun B, Li K, Zhu C (2020) One-step multichannel percutaneous transhepatic cholangioscopic lithotripsy applied in bilateral hepatolithiasis. World J Surg 44:1586–1594PubMedCrossRef

32.

Cianci P, Restini E (2021) Management of cholelithiasis with choledocholithiasis: endoscopic and surgical approaches. World J Gastroenterol 27:4536–4554PubMedPubMedCentralCrossRef

33.

Tan J, Tan Y, Chen F, Zhu Y, Leng J, Dong J (2015) Endoscopic or laparoscopic approach for hepatolithiasis in the era of endoscopy in China. Surg Endosc 29:154–162PubMedCrossRef

34.

Jiang YB, Liang B, Zheng JJ, Yang CM, Zhang JY (2022) Laparoscopic common bile duct exploration for treatment of common bile duct stones: clinical analysis of 158 cases. Zhongguo yi xue ke xue yuan xue bao Acta Academiae Medicinae Sinicae 44:286–289PubMed

35.

Ortega M, Marco F, Soriano A, Almela M, Martínez JA, López J, Pitart C, Mensa J (2012) Epidemiology and prognostic determinants of bacteraemic biliary tract infection. J Antimicrob Chemother 67:1508–1513PubMedCrossRef

36.

Gomi H, Solomkin JS, Schlossberg D, Okamoto K, Takada T, Strasberg SM, Ukai T, Endo I, Iwashita Y, Hibi T, Pitt HA, Matsunaga N, Takamori Y, Umezawa A, Asai K, Suzuki K, Han HS, Hwang TL, Mori Y, Yoon YS, Huang WS, Belli G, Dervenis C, Yokoe M, Kiriyama S, Itoi T, Jagannath P, Garden OJ, Miura F, de Santibañes E, Shikata S, Noguchi Y, Wada K, Honda G, Supe AN, Yoshida M, Mayumi T, Gouma DJ, Deziel DJ, Liau KH, Chen MF, Liu KH, Su CH, Chan ACW, Yoon DS, Choi IS, Jonas E, Chen XP, Fan ST, Ker CG, Giménez ME, Kitano S, Inomata M, Mukai S, Higuchi R, Hirata K, Inui K, Sumiyama Y, Yamamoto M (2018) Tokyo Guidelines 2018: antimicrobial therapy for acute cholangitis and cholecystitis. J Hepatobiliary Pancreat Sci 25:3–16PubMedCrossRef

37.

Yaghoubi S, Zekiy AO, Krutova M, Gholami M, Kouhsari E, Sholeh M, Ghafouri Z, Maleki F (2022) Tigecycline antibacterial activity, clinical effectiveness, and mechanisms and epidemiology of resistance: narrative review. Eur J Clin Microbiol Infect Dis 41:1003–1022PubMedCrossRef

38.

Wulkersdorfer B, Jaros D, Eberl S, Poschner S, Jäger W, Cosentini E, Zeitlinger M, Schwameis R (2017) Human bile reduces antimicrobial activity of selected antibiotics against enterococcus faecalis and Escherichia coli in vitro. Antimicrob Agents Chemother 61:10–1128CrossRef

39.

Xing D, Song W, Gong S, Xu A, Zhai B (2022) Analysis of the bacterial spectrum and key clinical factors of biliary tract infection in patients with malignant obstructive jaundice after PTCD. Dis Markers 2022:1026254PubMedPubMedCentralCrossRef

40.

vanSonnenberg E, Ferrucci JT Jr, Neff CC, Mueller PR, Simeone JF, Wittenberg J (1983) Biliary pressure: manometric and perfusion studies at percutaneous transhepatic cholangiography and percutaneous biliary drainage. Radiology 148:41–50PubMedCrossRef

41.

Pessaux P, Msika S, Atalla D, Hay JM, Flamant Y (2003) Risk factors for postoperative infectious complications in noncolorectal abdominal surgery: a multivariate analysis based on a prospective multicenter study of 4718 patients. Arch Surg (Chicago, IL: 1960) 138:314–324

42.

Huang ZQ, Xu LN, Yang T, Zhang WZ, Huang XQ, Cai SW, Zhang AQ, Feng YQ, Zhou NX, Dong JH (2009) Hepatic resection: an analysis of the impact of operative and perioperative factors on morbidity and mortality rates in 2008 consecutive hepatectomy cases. Chin Med J 122:2268–2277PubMed

43.

Gavazzi F, Ridolfi C, Capretti G, Angiolini MR, Morelli P, Casari E, Montorsi M, Zerbi A (2016) Role of preoperative biliary stents, bile contamination and antibiotic prophylaxis in surgical site infections after pancreaticoduodenectomy. BMC Gastroenterol 16:43PubMedPubMedCentralCrossRef

44.

Kessler S, Käfer W (2007) Overweight and obesity: two predictors for worse early outcome in total hip replacement? Obesity (Silver Spring, MD) 15:2840–2845PubMedCrossRef

45.

Makino T, Shukla PJ, Rubino F, Milsom JW (2012) The impact of obesity on perioperative outcomes after laparoscopic colorectal resection. Ann Surg 255:228–236PubMedCrossRef

46.

Hotouras A, Ribas Y, Zakeri SA, Nunes QM, Murphy J, Bhan C, Wexner SD (2016) The influence of obesity and body mass index on the outcome of laparoscopic colorectal surgery: a systematic literature review. Colorectal Dis 18:O337–O366PubMedCrossRef

47.

Kwan B, Waters PS, Keogh C, Cavallucci DJ, O’Rourke N, Bryant RD (2021) Body mass index and surgical outcomes in laparoscopic liver resections: a systematic review. ANZ J Surg 91:2296–2307PubMedCrossRef

48.

Stewart L, Griffiss JM, Jarvis GA, Way LW (2012) The association between body mass index and severe biliary infections: a multivariate analysis. Am J Surg 204:574–579PubMedCrossRef

Title: Risk factors analyses associated with postoperative infection in choledochoscopy for intrahepatic bile duct stones (IHDs): a single-center retrospective study in real-world setting
Authors: Yangyang Ou
Jianjun Li
Chunfeng Liang
Chongyuan Hu
Ming Yao
Yubin Huang
Xiaoyong Cai
Yihe Yan
Publication date: 01-03-2024
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 4/2024
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-024-10737-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Risk factors analyses associated with postoperative infection in choledochoscopy for intrahepatic bile duct stones (IHDs): a single-center retrospective study in real-world setting

Abstract

Background

Methods

Results

Conclusions

Graphical abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Graphical abstract

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Correction: Implementation of 3D printed superior mesenteric vascular models for surgical planning and/or navigation in right colectomy with extended D3 mesenterectomy: comparison of virtual and physical models to the anatomy found at surgery