Muhammad Younis1, Niv Pencovich2, Reut El-On1, Nir Lubezky1, Yaacov Goykhman1, Adam Phillips3, Ido Nachmany4. 1. Division of General Surgery, Department of General Surgery B, Tel Aviv Sourasky Medical Center, The Nikolas & Elizabeth Shlezak Fund for Experimental Surgery, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. 2. Department of General Surgery and Transplantation, Sheba Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Hashomer, 52621, Ramat-Gan, Israel. niv.pencovich1@gmail.com. 3. Department of Gastroenterology and Hepatology, Tel Aviv Sourasky Medical Center, The Nikolas & Elizabeth Shlezak Fund for Experimental Surgery, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. 4. Department of General Surgery and Transplantation, Sheba Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Hashomer, 52621, Ramat-Gan, Israel.
Abstract
BACKGROUND: Endoscopic retrograde cholangiopancreatography (ERCP) is the first line treatment for choledocholithiasis. In many occasions, several attempts of ERCP are performed until failure is declared and surgical treatment is applied, in many times following procedure-related complications. We present the results of surgical management of patients with choledocholithiasis following repeated failures of ERCP due to impaction of multiple large stones. METHODS: Patients that underwent surgical treatment for choledocholithiasis following repeated ERCP attempts between January 2006 and December 2018 were retrospectively assessed. Post-ERCP complications were evaluated and the surgical approach, technique, and outcomes were assessed. RESULTS: One hundred and two patients were operated on for choledocholithiasis following repeated failed ERCP. All the patients had at least 2 failed attempts (mean = 3.2 ± 1.7), and 25 (23.5%) suffered major ERCP-related complications. Following choledochotomy and stone extraction, bilioenteric anastomosis was done in the vast majority of patients (90.2%), most commonly choledochoduodenostomy (62%). Thirty-eight (37%) patients had minimally invasive procedure (laparoscopic n = 26, robotic assisted n = 12). Major post-operative complications (Clavien-Dindo ≥ 3) occurred in 24 patients (23.5%). Nine patients (8.8%) were re-operated and 10 (9.8%) were readmitted within 30 days from surgery. Three patients died within 30 days from surgery. Older patients had significantly more ERCP attempts and suffered higher post-operative mortality. During a median follow-up of 70 months, the only biliary complication was an anastomotic stricture in one patient. CONCLUSION: Surgery for CBDS after failure of ERCP is safe and provides a highly effective long-term solution.
BACKGROUND: Endoscopic retrograde cholangiopancreatography (ERCP) is the first line treatment for choledocholithiasis. In many occasions, several attempts of ERCP are performed until failure is declared and surgical treatment is applied, in many times following procedure-related complications. We present the results of surgical management of patients with choledocholithiasis following repeated failures of ERCP due to impaction of multiple large stones. METHODS: Patients that underwent surgical treatment for choledocholithiasis following repeated ERCP attempts between January 2006 and December 2018 were retrospectively assessed. Post-ERCP complications were evaluated and the surgical approach, technique, and outcomes were assessed. RESULTS: One hundred and two patients were operated on for choledocholithiasis following repeated failed ERCP. All the patients had at least 2 failed attempts (mean = 3.2 ± 1.7), and 25 (23.5%) suffered major ERCP-related complications. Following choledochotomy and stone extraction, bilioenteric anastomosis was done in the vast majority of patients (90.2%), most commonly choledochoduodenostomy (62%). Thirty-eight (37%) patients had minimally invasive procedure (laparoscopic n = 26, robotic assisted n = 12). Major post-operative complications (Clavien-Dindo ≥ 3) occurred in 24 patients (23.5%). Nine patients (8.8%) were re-operated and 10 (9.8%) were readmitted within 30 days from surgery. Three patients died within 30 days from surgery. Older patients had significantly more ERCP attempts and suffered higher post-operative mortality. During a median follow-up of 70 months, the only biliary complication was an anastomotic stricture in one patient. CONCLUSION: Surgery for CBDS after failure of ERCP is safe and provides a highly effective long-term solution.
Authors: Roi Weiser; Niv Pencovich; Liat Mlynarsky; Adi Berliner-Senderey; Guy Lahat; Erwin Santo; Joseph M Klausner; Ido Nachmany Journal: Surgery Date: 2016-12-24 Impact factor: 3.982
Authors: Jean-Marc Dumonceau; Christine Kapral; Lars Aabakken; Ioannis S Papanikolaou; Andrea Tringali; Geoffroy Vanbiervliet; Torsten Beyna; Mario Dinis-Ribeiro; Istvan Hritz; Alberto Mariani; Gregorios Paspatis; Franco Radaelli; Sundeep Lakhtakia; Andrew M Veitch; Jeanin E van Hooft Journal: Endoscopy Date: 2019-12-20 Impact factor: 10.093
Authors: Patricia Ruiz Cuesta; Antonio José Hervás Molina; María Muñoz García-Borruel; Juan Jurado García; Valle García Sánchez; María Pleguezuelo Navarro; Luis Leonardo Casáis Juanena; Antonio Naranjo Rodríguez Journal: Gastroenterol Hepatol Date: 2013-10-05 Impact factor: 2.102