期刊论文详细信息
Trauma Surgery & Acute Care Open
Win or lose, nighttime transcystic laparoscopic common bile duct exploration is a win
article
Gregory R Stettler1  Aravindh S Ganapathy2  Maggie E Bosley2  Audrey L Spencer1  Lucas P Neff3  Andrew M Nunn1  Preston R Miller1 
[1] Department of Surgery, Division of Trauma and Acute Care Surgery , Atrium Health Wake Forest Baptist Hospital;Department of Surgery , Wake Forest University School of Medicine;Department of Surgery, Division of Pediatric Surgery , Atrium Health Wake Forest Baptist Hospital
关键词: laparoscopy;    biliary tract;    cholecystectomy;    gallbladder;   
DOI  :  10.1136/tsaco-2022-001045
学科分类:社会科学、人文和艺术(综合)
来源: BMJ Publishing Group
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【 摘 要 】

Objectives Although controversial, recent data suggest nighttime versus daytime laparoscopic cholecystectomy (LC) have comparable outcomes. Laparoscopic common bile duct exploration (LCBDE) for choledocholithiasis decreases length of stay (LOS) as compared with LC with endoscopic retrograde cholangiopancreatography (ERCP) but increases case complexity/time. The influence of time of day on LCBDE outcomes has not been evaluated. Our aim was to examine outcomes and LOS for nighttime (PM) compared with daytime LC+LCBDE (DAY).Methods Consecutive patients who underwent LCBDE were reviewed. Demographics, operative duration, success of LCBDE, time to postoperative ERCP (if required), LOS, and complications were compared. PM procedures were defined as beginning 19:00–07:00 hours.Results Between 2018 and 2022, sixty patients underwent LCBDE (PM 42%). Groups had equivalent age/sex and preoperative liver function tests (LFTs). LCBDE success was 69% PM versus 71% DAY (p=0.78). Operative duration did not differ (2.8 IQR: 2.2–3.3 hours vs. 2.8 IQR: 2.3–3.2 hours, p=0.9). LOS was compared, and PM LOS was shorter (p=0.03). Time to ERCP after a failed LCBDE at night was compared with daytime (13.8 IQR: 10.6–29.5 hours vs. 19.9 IQR: 18.7–54.4 hours, p=0.07). LOS for failed PM LCBDE requiring ERCP was similar to successful DAY LCBDE (p=0.29). One complication (transient hyperbilirubinemia) was reported in the DAY group, none in PM.Conclusion PM LCBDE cases are equivalent in safety and success rate to DAY cases but have reduced LOS. Widespread adoption of acute care surgery-driven management of choledocholithiasis via LCBDE during cholecystectomy may decrease LOS, especially in PM cases.

【 授权许可】

CC BY-NC|CC BY|CC BY-NC-ND   

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