Laparoscopic endobiliary stenting significantly improves success of
postoperative endoscopic retrograde cholangiopancreatography in low-volume centers |
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Authors: | RD Fanelli KS Gersin MT Mainella |
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Institution: | (1) Department of Surgery, Berkshire Medical Center, University of Massachusetts Medical School, c/o Surgical Specialists of Western New England, PC, 510 North Street, Suite 202, Pittsfield, MA 01201, USA, US;(2) Department of Surgery, University of Cincinnati Medical Center, 231 Bethesda Avenue, MSB 2455, Cincinnati, OH 45267, USA, US;(3) Department of Surgery, Berkshire Medical Center, 725 North Street, Pittsfield, MA 01201, USA, US |
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Abstract: | Background: Occult common bile duct stones (CBDS) discovered during laparoscopic cholecystectomy with intraoperative cholangiography
are most often managed by postoperative endoscopic retrograde cholangiopancreatography (ERCP). Expert endoscopists at high-volume
centers achieve common bile duct cannulation in nearly all patients undergoing ERCP, but cannulation rates of less than 80%
have been observed in low-volume centers. As many as 20% of patients with CBDS referred for postoperative ERCP in low-volume
centers may require repeated attempts at ERCP, referral to a high-volume center, percutaneous transhepatic techniques, or
reoperation for clearance of CBDS when postoperative ERCP fails. Methods: Laparoscopic cholecystectomy with intraoperative
cholangiography performed in 511 consecutive patients over 80 months at a community hospital showed occult CBDS in 66 patients
(12.9%). Laparoscopic endobiliary stent placement was successful in 65 patients (98.5%). As part of an earlier study, 16 patients
underwent laparoscopic common bile duct exploration with clearance of CBDS before stent placement. Laparoscopic endobiliary
stent placement failed in one patient for whom CBDS were cleared with intraoperative ERCP. Results: Initial postoperative
ERCP was successful in clearing CBDS in all 65 patients (100%) with laparoscopically placed stents. During the same period,
611 patients underwent ERCP for various indications including CBDS (43%). Selective cannulation was achieved in 78% of all
patients during initial ERCP. Conclusions: Laparoscopic endobiliary stent placement is an effective adjunct to the management
of occult CBDS. Laparoscopic endobiliary stenting ensures selective cannulation during postoperative ERCP and eliminates the
need for repeated attempts at ERCP, referral to specialty centers, use of transhepatic techniques, or reoperation for retained
CBDS. Laparoscopic endobiliary stent placement for treatment of occult CBDS significantly improves the success of postoperative
ERCP in low-volume centers and eliminates the morbidity and expense of repeated procedures. |
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