nach oben

Erschienen in:

03.04.2018 | Original Scientific Report

Acute Pancreatitis After Laparoscopic Transcystic Common Bile Duct Exploration: An Analysis of Predisposing Factors in 447 Patients

verfasst von: Matias E. Czerwonko, Juan Pekolj, Pedro Uad, Oscar Mazza, Rodrigo Sanchez-Claria, Guillermo Arbues, Eduardo de Santibañes, Martín de Santibañes, Martín Palavecino

Erschienen in: World Journal of Surgery | Ausgabe 10/2018

Einloggen, um Zugang zu erhalten

Abstract

Introduction

In laparoscopic transcystic common bile duct exploration (LTCBDE), the risk of acute pancreatitis (AP) is well recognized. The present study assesses the incidence, risk factors, and clinical impact of AP in patients with choledocholithiasis treated with LTCBDE.

Methods

A retrospective database was completed including patients who underwent LTCBDE between 2007 and 2017. Univariate and multivariate analyses were performed by logistic regression.

Results

After exclusion criteria, 447 patients were identified. There were 70 patients (15.7%) who showed post-procedure hyperamylasemia, including 20 patients (4.5%) who developed post-LTCBDE AP. Of these, 19 were edematous and one was a necrotizing pancreatitis. Patients with post-LTCBDE AP were statistically more likely to have leukocytosis (p < 0.004) and jaundice (p = 0.019) before surgery and longer operative times (OT, p < 0.001); they were less likely to have incidental intraoperative diagnosis (p = 0.031) or to have biliary colic as the reason for surgery (p = 0.031). In the final multivariate model, leukocytosis (p = 0.013) and OT (p < 0.001) remained significant predictors for AP. Mean postoperative hospital stay (HS) was significantly longer in AP group (p < 0.001).

Conclusion

The risk of AP is moderate and should be considered in patients with preoperative leukocytosis and jaundice and exposed to longer OT. AP has a strong impact on postoperative HS.

Dasari BV, Tan CJ, Gurusamy KS, Martin DJ, Kirk G, McKie L et al (2013) Surgical versus endoscopic treatment of bile duct stones. In: Dasari BV (ed) Cochrane database of systematic reviews. Wiley, Chichester. p. CD003327 (cited 2017 Jul 2). http://www.ncbi.nlm.nih.gov/pubmed/24338858

Aawsaj Y, Light D, Horgan L (2016) Laparoscopic common bile duct exploration: 15-year experience in a district general hospital. Surg Endosc 30(6):2563–2566. https://doi.org/10.1007/s00464-015-4523-0 CrossRefPubMed

Cai Y, Liu X (2014) Laparoscopic choledochotomy followed by primary duct closure for choledocholithiasis. Surg Endosc 28(5):1750–1751. https://doi.org/10.1007/s00464-013-3395-4 CrossRefPubMed

Khaled YS, Malde DJ, de Souza C, Kalia A, Ammori BJ (2013) Laparoscopic bile duct exploration via choledochotomy followed by primary duct closure is feasible and safe for the treatment of choledocholithiasis. Surg Endosc 27(11):4164–4170. https://doi.org/10.1007/s00464-013-3015-3 CrossRefPubMed

Zhu H-Y, Xu M, Shen H-J, Yang C, Li F, Li K et al (2015) A meta-analysis of single-stage versus two-stage management for concomitant gallstones and common bile duct stones. Clin Res Hepatol Gastroenterol 39(5):584–593CrossRefPubMed

Kenny R, Richardson J, McGlone ER, Reddy M, Khan OA (2014) Laparoscopic common bile duct exploration versus pre or post-operative ERCP for common bile duct stones in patients undergoing cholecystectomy: is there any difference? Int J Surg 12(9):989–993CrossRefPubMed

Lauter DM, Froines EJ (2000) Laparoscopic common duct exploration in the management of choledocholithiasis. Am J Surg 179(5):372–374CrossRefPubMed

Banks PA, Bollen TL, Dervenis C, Gooszen HG, Johnson CD, Sarr MG et al (2013) Classification of acute pancreatitis—2012: revision of the Atlanta classification and definitions by international consensus. Gut 62(1):102–111CrossRefPubMed

Dindo D, Demartines N, Clavien P-A (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213CrossRefPubMedPubMedCentral

10.

Pekolj J, Alvarez FA, Palavecino M, Sánchez Clariá R, Mazza O, de Santibañes E (2013) Intraoperative management and repair of bile duct injuries sustained during 10,123 laparoscopic cholecystectomies in a high-volume referral center. J Am Coll Surg 216(5):894–901CrossRefPubMed

11.

Clayton ESJ, Connor S, Alexakis N, Leandros E (2006) Meta-analysis of endoscopy and surgery versus surgery alone for common bile duct stones with the gall bladder in situ. Br J Surg 93(10):1185–1191CrossRefPubMed

12.

Paganini AM, Feliciotti F, Guerrieri M, Tamburini A, De Sanctis A, Campagnacci R et al (2001) Laparoscopic common bile duct exploration. J Laparoendosc Adv Surg Tech A 11(6):391–400. https://doi.org/10.1089/10926420152761923 CrossRefPubMed

13.

Akashi R, Kiyozumi T, Tanaka T, Sakurai K, Oda Y, Sagara K (2002) Mechanism of pancreatitis caused by ERCP. Gastrointest Endosc 55(1):50–54CrossRefPubMed

14.

Cohen SA, Siegel JH, Kasmin FE (1996) Complications of diagnostic and therapeutic ERCP. Abdom Imaging 21(5):385–394CrossRefPubMed

15.

Messmann H, Vogt W, Holstege A, Lock G, Heinisch A, von Fürstenberg A et al (1997) Post-ERP pancreatitis as a model for cytokine induced acute phase response in acute pancreatitis. Gut 40(1):80–85CrossRefPubMedPubMedCentral

16.

Oezcueruemez-Porsch M, Kunz D, Hardt PD, Fadgyas T, Kress O, Schulz HU et al (1998) Diagnostic relevance of interleukin pattern, acute-phase proteins, and procalcitonin in early phase of post-ERCP pancreatitis. Dig Dis Sci 43(8):1763–1769CrossRefPubMed

17.

Dumonceau J-M, Andriulli A, Elmunzer BJ, Mariani A, Meister T, Deviere J et al (2014) Prophylaxis of post-ERCP pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) guideline—updated June 2014. Endoscopy 46(9):799–815. https://doi.org/10.1055/s-0034-1377875 CrossRefPubMed

18.

Hua J, Meng H, Yao L, Gong J, Xu B, Yang T et al (2016) Five hundred consecutive laparoscopic common bile duct explorations: 5-year experience at a single institution. Surg Endosc. https://doi.org/10.1007/s00464-016-5388-6 CrossRefPubMed

19.

Flum DR, Koepsell T, Heagerty P, Sinanan M, Dellinger EP (2001) Common bile duct injury during laparoscopic cholecystectomy and the use of intraoperative cholangiography: adverse outcome or preventable error? Arch Surg 136(11):1287–1292CrossRefPubMed

20.

Flum DR, Dellinger EP, Cheadle A, Chan L, Koepsell T (2003) Intraoperative cholangiography and risk of common bile duct injury during cholecystectomy. JAMA 289(13):1639–1644. https://doi.org/10.1001/jama.289.13.1639 CrossRefPubMed

21.

Waage A, Nilsson M (2006) Iatrogenic bile duct injury: a population-based study of 152,776 cholecystectomies in the Swedish Inpatient Registry. Arch Surg 141(12):1207–1213CrossRefPubMed

22.

Flowers JL, Zucker KA, Graham SM, Scovill WA, Imbembo AL, Bailey RW (1992) Laparoscopic cholangiography. Results and indications. Ann Surg 215(3):209–216CrossRefPubMedPubMedCentral

23.

Ludwig K, Bernhardt J, Steffen H, Lorenz D (2002) Contribution of intraoperative cholangiography to incidence and outcome of common bile duct injuries during laparoscopic cholecystectomy. Surg Endosc 16(7):1098–1104. https://doi.org/10.1007/s00464-001-9183-6 CrossRefPubMed

24.

Z’graggen K, Wehrli H, Metzger A, Buehler M, Frei E, Klaiber C (1998) Complications of laparoscopic cholecystectomy in Switzerland. A prospective 3-year study of 10,174 patients. Swiss Association of Laparoscopic and Thoracoscopic Surgery. Surg Endosc 12(11):1303–1310CrossRefPubMed

25.

Phillips EH (1993) Routine versus selective intraoperative cholangiography. Am J Surg 165(4):505–507CrossRefPubMed

26.

Podnos YD, Gelfand DV, Dulkanchainun TS, Wilson SE, Cao S, Ji P et al (2001) Is intraoperative cholangiography during laparoscopic cholecystectomy cost effective? Am J Surg 182(6):663–669CrossRefPubMed

27.

Fletcher DR, Hobbs MS, Tan P, Valinsky LJ, Hockey RL, Pikora TJ et al (1999) Complications of cholecystectomy: risks of the laparoscopic approach and protective effects of operative cholangiography: a population-based study. Ann Surg 229(4):449–457CrossRefPubMedPubMedCentral

28.

Kumar A, Kumar U, Munghate A, Bawa A (2015) Role of routine intraoperative cholangiography during laparoscopic cholecystectomy. Surg Endosc 29(9):2837–2840CrossRefPubMed

29.

Balandraud P, Biance N, Peycru T, Tardat E, Bonnet P-M, Cazeres C et al (2008) Fortuitous discovery of common bile duct stones: results of a conservative strategy. Gastroenterol Clin Biol 32(4):408–412CrossRefPubMed

30.

Caddy GR, Kirby J, Kirk SJ, Allen MJ, Moorehead RJ, Tham TC (2005) Natural history of asymptomatic bile duct stones at time of cholecystectomy. Ulster Med J 74(2):108–112PubMedPubMedCentral

31.

Al-Bahrani AZ, Holt A, Hamade AM, Abid GH, Laasch H-U, O’Shea SJ et al (2006) Acute pancreatitis: an under-recognized risk of percutaneous transhepatic distal biliary intervention. HPB (Oxford) 8(6):446–450CrossRef

32.

Mairose UB, Wurbs D, Classen M (1978) Santorini’s Duct—an insignificant variant from normal or an important overflow valve? Endoscopy 10(1):24–29. https://doi.org/10.1055/s-0028-1098256 CrossRefPubMed

33.

Asselah T, Condat B, Sibert A, Rivet P, Lebray P, Bernuau J et al (2001) Haemobilia causing acute pancreatitis after percutaneous liver biopsy: diagnosis by magnetic resonance cholangiopancreatography. Eur J Gastroenterol Hepatol 13(7):877–879CrossRefPubMed

34.

Kim HJ, Shin JH, Lee YY, Lee JK, Yim BC, Park UT et al (1999) Hemobilia causing acute biliary pancreatitis after percutaneous liver biopsy. Endoscopy 31(3):S18–S19PubMed

35.

Van Os EC, Petersen BT (1996) Pancreatitis secondary to percutaneous liver biopsy-associated hemobilia. Am J Gastroenterol 91(3):577–580PubMed

36.

Russolillo N, Massobrio A, Langella S, Lo Tesoriere R, Carbonatto P, Ferrero A (2017) Acute pancreatitis after percutaneous biliary drainage: an obstacle in liver surgery for proximal biliary cancer. World J Surg 41(6):1595–1600. https://doi.org/10.1007/s00268-017-3885-y CrossRefPubMed

37.

Dinkel HP, Triller J (2001) Primary and long-term success of percutaneous biliary metallic endoprotheses (Wallstents) in malignant obstructive jaundice. Rofo 173(12):1072–1078. https://doi.org/10.1055/s-2001-18889 CrossRefPubMed

38.

Davies NM, Anderson KE (1997) Clinical pharmacokinetics of diclofenac. Therapeutic insights and pitfalls. Clin Pharmacokinet 33(3):184–213. https://doi.org/10.2165/00003088-199733030-00003 CrossRefPubMed

39.

Gross V, Leser HG, Heinisch A, Schölmerich J (1993) Inflammatory mediators and cytokines—new aspects of the pathophysiology and assessment of severity of acute pancreatitis? Hepatogastroenterology 40(6):522–530PubMed

40.

Mäkelä A, Kuusi T, Schröder T (1997) Inhibition of serum phospholipase-A2 in acute pancreatitis by pharmacological agents in vitro. Scand J Clin Lab Invest 57(5):401–407. https://doi.org/10.3109/00365519709084587 CrossRefPubMed

41.

Yuhara H, Ogawa M, Kawaguchi Y, Igarashi M, Shimosegawa T, Mine T (2014) Pharmacologic prophylaxis of post-endoscopic retrograde cholangiopancreatography pancreatitis: protease inhibitors and NSAIDs in a meta-analysis. J Gastroenterol 49(3):388–399. https://doi.org/10.1007/s00535-013-0834-x CrossRefPubMed

42.

Yaghoobi M, Rolland S, Waschke KA, McNabb-Baltar J, Martel M, Bijarchi R et al (2013) Meta-analysis: rectal indomethacin for the prevention of post-ERCP pancreatitis. Aliment Pharmacol Ther 38(9):995–1001. https://doi.org/10.1111/apt.12488 CrossRefPubMed

43.

Sun H-L, Han B, Zhai H-P, Cheng X-H, Ma K (2014) Rectal NSAIDs for the prevention of post-ERCP pancreatitis: a meta-analysis of randomized controlled trials. Surgeon 12(3):141–147CrossRefPubMed

44.

Sethi S, Sethi N, Wadhwa V, Garud S, Brown A (2014) A meta-analysis on the role of rectal diclofenac and indomethacin in the prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis. Pancreas 43(2):190–197CrossRefPubMed

45.

Elmunzer BJ, Waljee AK, Elta GH, Taylor JR, Fehmi SMA, Higgins PDR (2008) A meta-analysis of rectal NSAIDs in the prevention of post-ERCP pancreatitis. Gut 57(9):1262–1267. https://doi.org/10.1136/gut.2007.140756 CrossRefPubMed

46.

Ding X, Chen M, Huang S, Zhang S, Zou X (2012) Nonsteroidal anti-inflammatory drugs for prevention of post-ERCP pancreatitis: a meta-analysis. Gastrointest Endosc 76(6):1152–1159CrossRefPubMed

47.

Yokoe M, Takada T, Mayumi T, Yoshida M, Isaji S, Wada K et al (2015) Japanese guidelines for the management of acute pancreatitis: Japanese guidelines 2015. J Hepatobiliary Pancreat Sci 22(6):405–432CrossRefPubMed

48.

ASGE Standards of Practice Committee V, Chandrasekhara V, Khashab MA, Muthusamy VR, Acosta RD, Agrawal D et al (2017) Adverse events associated with ERCP. Gastrointest Endosc 85(1):32–47CrossRef

49.

Freeman ML, DiSario JA, Nelson DB, Fennerty MB, Lee JG, Bjorkman DJ et al (2001) Risk factors for post-ERCP pancreatitis: a prospective, multicenter study. Gastrointest Endosc 54(4):425–434CrossRefPubMed

Titel: Acute Pancreatitis After Laparoscopic Transcystic Common Bile Duct Exploration: An Analysis of Predisposing Factors in 447 Patients
verfasst von: Matias E. Czerwonko
Juan Pekolj
Pedro Uad
Oscar Mazza
Rodrigo Sanchez-Claria
Guillermo Arbues
Eduardo de Santibañes
Martín de Santibañes
Martín Palavecino
Publikationsdatum: 03.04.2018
Verlag: Springer International Publishing
Erschienen in: World Journal of Surgery / Ausgabe 10/2018
Print ISSN: 0364-2313
Elektronische ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-018-4611-0

Neu im Fachgebiet Chirurgie

Vorsicht, erhöhte Blutungsgefahr nach PCI!

10.05.2024 Koronare Herzerkrankung Nachrichten

Nach PCI besteht ein erhöhtes Blutungsrisiko, wenn die Behandelten eine verminderte linksventrikuläre Ejektionsfraktion aufweisen. Das Risiko ist umso höher, je stärker die Pumpfunktion eingeschränkt ist.

Darf man die Behandlung eines Neonazis ablehnen?

08.05.2024 Gesellschaft Nachrichten

In einer Leseranfrage in der Zeitschrift Journal of the American Academy of Dermatology möchte ein anonymer Dermatologe bzw. eine anonyme Dermatologin wissen, ob er oder sie einen Patienten behandeln muss, der eine rassistische Tätowierung trägt.

Deutlich weniger Infektionen: Wundprotektoren schützen!

08.05.2024 Postoperative Wundinfektion Nachrichten

Der Einsatz von Wundprotektoren bei offenen Eingriffen am unteren Gastrointestinaltrakt schützt vor Infektionen im Op.-Gebiet – und dient darüber hinaus der besseren Sicht. Das bestätigt mit großer Robustheit eine randomisierte Studie im Fachblatt JAMA Surgery.

Chirurginnen und Chirurgen sind stark suizidgefährdet

07.05.2024 Suizid Nachrichten

Der belastende Arbeitsalltag wirkt sich negativ auf die psychische Gesundheit der Angehörigen ärztlicher Berufsgruppen aus. Chirurginnen und Chirurgen bilden da keine Ausnahme, im Gegenteil.

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Aktuelle BDC Leitlinien-Webinare

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

Karpaltunnelsyndrom BDC Leitlinien Webinare

CME: 2 Punkte

Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis

S2e-Leitlinie „Distale Radiusfraktur“

Radiusfraktur BDC Leitlinien Webinare

CME: 2 Punkte

Das Webinar beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske

Dr. med. Benjamin Meyknecht

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

Appendizitis BDC Leitlinien Webinare

CME: 2 Punkte

Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric

Die Highlights vom Kongress des American College of Cardiology 2024

Springer Medizin

Acute Pancreatitis After Laparoscopic Transcystic Common Bile Duct Exploration: An Analysis of Predisposing Factors in 447 Patients