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Common Duct Stones (common + duct_stone)
Selected AbstractsMicrobiological assessment of bile during cholecystectomy: is all bile infected?HPB, Issue 3 2007G.J. MORRIS-STIFF Abstract Aims. To determine the prevalence of bactibilia in patients undergoing cholecystectomy and to relate the presence or absence of organisms to the preoperative and postoperative course. Patients and methods. Patients undergoing cholecystectomy under the care of a single consultant surgeon during a continuous 5-year period were identified from a prospectively maintained departmental database. Symptoms, clinical signs, findings of investigations, details of treatment and postoperative care were noted. Risk factors for bactibilia (acute cholecystitis, common duct stones, emergency surgery, intraoperative findings and age > 70 years) were documented. Patients were divided according to the presence (B +) or absence (B,) of bacteria on culture of their bile. Results. In all, 128/180 (70%) of cholecystectomies had full data available for analysis. Bacteria were identified in the bile of 20 (15.6%) patients (B+ group). The B+ group was significantly older at 63.78±9.7 versus 61.62±13.9 (p<0.05) and contained significantly fewer females than the B, group (p<0.05). All 20 patients (100%) in the B+ group had , 1 risk factor, while these factors were present in only 29/108 (30.3%) of patients in the B, group (p<0.05). The overall incidence of infective complications was 20% in the B+ group compared with 0.9% in the B, group (p<0.05) and the bile-related infections were higher in the B+ group (p<0.05). Conclusions. The study demonstrated that while patients with complicated gallstone disease frequently exhibit bactibilia, patients with uncomplicated cholelithiasis have aseptic bile. The findings would suggest that prophylactic antibiotics should be limited to patients with risk factors for bactibilia. [source] Surgical strategies in the laparoscopic therapy of cholecystolithiasis and common duct stonesANZ JOURNAL OF SURGERY, Issue 8 2002Kaja Ludwig Background: The purpose of the present study was to examine the current approach and different strategies adopted for laparoscopic cholecystectomy in Germany. Methods: A retrospective survey was conducted at 859 (n = 1200; 67.6%) hospitals in Germany. Data from 123 090 patients who had undergone cholecystectomy were analysed. Results: 71.9% of the operations were finished laparoscopically (n= 88 537) whereas 22.5% were carried out using the open technique. Conversion to open surgery was required in 7.1% of the laparoscopically started operations. When common bile duct stones were diagnosed preoperatively, 74.4% of the participants favoured the primary endoscopic extraction, following laparoscopic cholecystectomy. In cases of intraoperative diagnoses, laparoscopic cholecystectomy was finished and postoperative primary endoscopic extraction was carried out in more than half of the hospitals (58.4%). Sixteen per cent converted to an open operation with simultaneous exploration of the common duct. Laparoscopic desobstruction of the common bile duct was extremely rare (4.4%). Compared with open cholecystectomy, the results show a lower incidence of postoperative reinterventions (0.9 vs 1.8%) and fatal outcomes (0.04 vs 0.53%) for laparoscopic cholecystectomy. In contrast, common bile duct injuries were more frequent in the laparoscopic cholecystectomy group (0.32 vs 0.12%). The median duration of hospitalization was 6.1 days (range: 2.8,12) in the laparoscopic cholecystectomy group compared with 10.4 days (range: 3,28) in the open cholecystectomy group. Conclusions: Laparoscopic cholecystectomy is the standard procedure for the treatment of uncomplicated gallstone disease. There are reasonable differences between the hospitals in type of cholecystectomy for acute cholecystitis, management of common duct stones and intraoperative diagnostics in laparoscopic cholecystectomy, even after adjustment for differences in patient comorbidities. [source] The value of magnetic resonance cholangiopancreatography in predicting common bile duct stones in patients with gallstone disease,BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 1 2003B. Topal Background: The application of available predictive scoring systems for the detection of common bile duct (CBD) stones has not reduced the number of patients who undergo unnecessary endoscopic retrograde cholangiopancreatography. The aim of this study was to create a predictive model for CBD stones and to assess the value of magnetic resonance cholangiopancreatography (MRCP) in prediction. Methods: In 1998, 366 patients with gallstone disease (118 males, 248 females; mean age 57 (range 8,84) years) underwent cholecystectomy. Statistical analysis was performed on patient data obtained at the time of first presentation. Results: CBD stones were demonstrated in 43 (12 per cent) of 366 patients. The predictive model for common duct stones included ultrasonography showing CBD stones or bile duct dilatation, age greater than 60 years, fever, serum alkaline phosphatase level above 670 units/l and serum amylase level above 95 units/l. In patients with a predicted probability greater than 5 per cent, CBD stones were present in 11 per cent, compared with 1 per cent in patients with a probability of 5 per cent or less. MRCP had an observed sensitivity of 95 per cent, specificity of 100 per cent, positive predictive value of 100 per cent and negative predictive value of 98 per cent. Conclusion: In patients with a predicted probability for CBD stones of more than 5 per cent, MRCP is recommended in order to confirm the presence or absence of stones and as guidance in further management. Copyright © 2003 British Journal of Surgery Society Ltd. Published by John Wiley & Sons Ltd [source] Potential of laparoscopic ultrasonography as an alternative to operative cholangiography in the detection of bile duct stonesBRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 1 2001S. E. Tranter Background: Intraoperative cholangiography (IOC) is time consuming, requires radiation and sometimes fails. In contrast, laparoscopic ultrasonography (LUS) is a comparatively quick, safe and non-invasive technique. The aim of this study was to assess the potential of LUS as an alternative to IOC. Methods: LUS was performed on 367 patients undergoing laparoscopic cholecystectomy. Laparoscopic duct exploration was performed in the presence of duct stones. Data were collected prospectively. The presence or absence and number of duct stones detected by LUS were recorded. The maximum bile duct diameter determined by LUS was compared with a preoperative ultrasonographic measurement according to age and the presence of duct stones. The final arbiter was the demonstration of stones removed at laparoscopic duct exploration (59 patients) or subsequently by endoscopic retrograde cholangiopancreatography (two patients). Results: LUS visualized the CBD in 99 per cent of patients and the common hepatic duct in 92 per cent. It identified stones in 56 of the 61 patients with duct stones. No stones were demonstrated in the remaining 306 patients (sensitivity 92 per cent, specificity 100 per cent, positive predictive value 100 per cent, negative predictive value 98 per cent). LUS underestimated the total number of stones in 18 per cent of patients with common duct stones. The mean common bile duct diameter was 5·0 mm before operation and 5·9 mm during the procedure in patients without duct stones, rising significantly to a mean of 9·2 mm before operation and 11·2 mm at LUS in those with duct stones (P < 0·0001). Conclusion: The combination of the demonstration of duct stones and bile duct diameter measurement makes LUS a potential replacement for IOC. Improved demonstration of the common hepatic duct would be advantageous. © 2001 British Journal of Surgery Society Ltd [source] | ||||||||||