Mats Möller1, Ulf Gustafsson1, Finn Rasmussen2, Gunnar Persson3, Anders Thorell1. 1. Department of Surgery, Ersta Hospital, Stockholm, Sweden2Department of Clinical Sciences, Karolinska Institutet, Danderyds Hospital, Stockholm, Sweden. 2. Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden. 3. Department of Surgery, Ryhov Hospital, Jönköping, Sweden.
Abstract
IMPORTANCE: The optimal strategy for common bile duct stones (CBDSs) encountered during cholecystectomy is yet to be determined. OBJECTIVE: To evaluate the outcomes after various interventional techniques to clear the bile ducts and the natural course of CBDSs found during intraoperative cholangiography. DESIGN, SETTING, AND PARTICIPANTS: In a large retrospective cohort analysis, we analyzed data from the Swedish Registry for Gallstone Surgery and Endoscopic Retrograde Cholangiopancreatography (GallRiks). We included all patients with CBDSs found on intraoperative cholangiography during cholecystectomy from May 1, 2005, through December 31, 2009. EXPOSURES: Presence of CBDSs on intraoperative cholangiography. MAIN OUTCOMES AND MEASURES: Relation between strategies for handling CBDSs in terms of complication rates and/or incomplete clearance with need of intervention (ie, unfavorable outcomes). RESULTS: In 38,864 cholecystectomies, CBDSs were found in 3969 patients, of whom 3828 underwent analysis. Earlier or ongoing symptoms were more common with increasing stone size (P < .001). In total, postoperative unfavorable outcomes were found in 14.9% but less frequently for patients with smaller stones (P < .01). Among patients in whom no intraoperative measures were taken (representing natural course), the risk for unfavorable outcomes was 25.3%. This risk was significantly lower in patients in whom any measure was taken to clear the ducts (12.7%; odds ratio, 0.44 [95% CI, 0.35-0.55]). The same was found when small (<4 mm) and medium (4-8 mm) stones were analyzed separately (odds ratio, 0.52 [95% CI, 0.34-0.79] and 0.24 [95% CI, 0.17-0.32], respectively). CONCLUSIONS AND RELEVANCE: The high rates of unfavorable outcomes associated with taking no measures when CBDSs are found during cholecystectomy suggest that the natural course might not be as favorable as earlier suggested. This finding implies that, in general, efforts should be made to clear the bile ducts.
IMPORTANCE: The optimal strategy for common bile duct stones (CBDSs) encountered during cholecystectomy is yet to be determined. OBJECTIVE: To evaluate the outcomes after various interventional techniques to clear the bile ducts and the natural course of CBDSs found during intraoperative cholangiography. DESIGN, SETTING, AND PARTICIPANTS: In a large retrospective cohort analysis, we analyzed data from the Swedish Registry for Gallstone Surgery and Endoscopic Retrograde Cholangiopancreatography (GallRiks). We included all patients with CBDSs found on intraoperative cholangiography during cholecystectomy from May 1, 2005, through December 31, 2009. EXPOSURES: Presence of CBDSs on intraoperative cholangiography. MAIN OUTCOMES AND MEASURES: Relation between strategies for handling CBDSs in terms of complication rates and/or incomplete clearance with need of intervention (ie, unfavorable outcomes). RESULTS: In 38,864 cholecystectomies, CBDSs were found in 3969 patients, of whom 3828 underwent analysis. Earlier or ongoing symptoms were more common with increasing stone size (P < .001). In total, postoperative unfavorable outcomes were found in 14.9% but less frequently for patients with smaller stones (P < .01). Among patients in whom no intraoperative measures were taken (representing natural course), the risk for unfavorable outcomes was 25.3%. This risk was significantly lower in patients in whom any measure was taken to clear the ducts (12.7%; odds ratio, 0.44 [95% CI, 0.35-0.55]). The same was found when small (<4 mm) and medium (4-8 mm) stones were analyzed separately (odds ratio, 0.52 [95% CI, 0.34-0.79] and 0.24 [95% CI, 0.17-0.32], respectively). CONCLUSIONS AND RELEVANCE: The high rates of unfavorable outcomes associated with taking no measures when CBDSs are found during cholecystectomy suggest that the natural course might not be as favorable as earlier suggested. This finding implies that, in general, efforts should be made to clear the bile ducts.
Authors: Anne Mattila; Emilia Pynnönen; Antti Sironen; Eeva Elomaa; Johanna Mrena; Aapo Jalkanen; Mika Nevalainen; Olli Helminen Journal: Updates Surg Date: 2022-10-07
Authors: Rutger Quispel; Hannah M Schutz; Nora D Hallensleben; Abha Bhalla; Robin Timmer; Jeanin E van Hooft; Niels G Venneman; Nicole S Erler; Bart J Veldt; Lydi M J W van Driel; Marco J Bruno Journal: Endosc Int Open Date: 2021-05-27