An analysis of omitting biliary tract imaging in 668 subjects admitted to an acute care surgery service with biochemical evidence of choledocholithiasis |
| |
Authors: | Andrew J Riggle Michael W Cripps Laindy Liu Madhu Subramanian Paul A Nakonezny Steven E Wolf Herb A Phelan |
| |
Institution: | 1. Department of Surgery, UT Southwestern Medical Center, Parkland Memorial Hospital, Dallas, TX, USA;2. Division of Burn/Trauma/Critical Care, Department of Surgery, UT Southwestern Medical Center, Parkland Memorial Hospital, 5323 Harry Hines Boulevard, E5.508A, Dallas, TX 75390-9158, USA;3. UT Southwestern School of Medicine, Dallas, TX, USA;4. Division of Biostatistics, Department of Clinical Sciences, UT Southwestern Medical Center, Dallas, TX, USA |
| |
Abstract: | BackgroundNo consensus exists for the timing and utility of biliary imaging in patients with preoperative concern for choledocholithiasis.MethodsAdmissions to an acute care surgery service with evidence of choledocholithiasis undergoing same-admission cholecystectomy without preoperative or intraoperative imaging were identified. One-way analysis of variance on the log-transformed outcomes, with the Tukey-Kramer multiple comparison procedure, were used to compare means between groups.ResultsA total of 668 patients with elevated but downtrending liver enzymes underwent cholecystectomy without preoperative or intraoperative imaging. Thirty-eight patients (5.7%) had postoperative biliary imaging, of whom 22 (3.3%) had definite choledocholithiasis. One case of postoperative cholangitis occurred which required readmission and endoscopic retrograde cholangiopancreatography with no long-term morbidity. Presenting liver enzymes were significantly higher in the group found to have retained stones postoperatively than those without retained stones.ConclusionsPatients presenting with biochemical evidence of choledocholithiasis who downtrend preoperatively can be safely managed by cholecystectomy with omission of biliary tract imaging. |
| |
Keywords: | Choledocholithiasis ERCP Liver function tests Intraoperative cholangiogram |
本文献已被 ScienceDirect 等数据库收录! |
|