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World Journal of Emergency Surgery :... Feb 2023Common bile duct exploration (CBDE) is safe and effective for managing choledocholithiasis, but most US general surgeons have limited experience with CBDE and are...
BACKGROUND
Common bile duct exploration (CBDE) is safe and effective for managing choledocholithiasis, but most US general surgeons have limited experience with CBDE and are uncomfortable performing this procedure in practice. Surgical trainee exposure to CBDE is limited, and their learning curve for achieving autonomous, practice-ready performance has not been previously described. This study tests the hypothesis that receipt of one or more prior CBDE operative performance assessments, combined with formative feedback, is associated with greater resident operative performance and autonomy.
METHODS
Resident and attending assessments of resident operative performance and autonomy were obtained for 189 laparoscopic or open CBDEs performed at 28 institutions. Performance and autonomy were graded along validated ordinal scales. Cases in which the resident had one or more prior CBDE case evaluations (n = 48) were compared with cases in which the resident had no prior evaluations (n = 141).
RESULTS
Compared with cases in which the resident had no prior CBDE case evaluations, cases with a prior evaluation had greater proportions of practice-ready or exceptional performance ratings according to both residents (27% vs. 11%, p = .009) and attendings (58% vs. 19%, p < .001) and had greater proportions of passive help or supervision only autonomy ratings according to both residents (17% vs. 4%, p = .009) and attendings (69% vs. 32%, p < .01).
CONCLUSIONS
Residents with at least one prior CBDE evaluation and formative feedback demonstrated better operative performance and received greater autonomy than residents without prior evaluations, underscoring the propensity of feedback to help residents achieve autonomous, practice-ready performance for rare operations.
Topics: Humans; Internship and Residency; Formative Feedback; Choledocholithiasis; Laparoscopy; Common Bile Duct
PubMed: 36747289
DOI: 10.1186/s13017-023-00480-0 -
Journal of Veterinary Science Sep 2018The feasibility of using computed tomography (CT) to identify the common bile duct (CBD) and comparison with ultrasonography (US) results were evaluated in normal beagle... (Comparative Study)
Comparative Study
The feasibility of using computed tomography (CT) to identify the common bile duct (CBD) and comparison with ultrasonography (US) results were evaluated in normal beagle dogs and dogs without hepatobiliary and pancreatic diseases. In addition, CBD diameters were obtained from CT at the level of the porta hepatis and the duodenal papilla level in dogs with underlying diseases that may cause cholestasis. US is a useful modality in the estimation of gallbladder volume because ejection fraction and CBD diameter from US were not significantly different from those of CT. The normal biliary tract was visible on CT images in 68% of the normal dog group. CBD diameter was not over 3 mm and 3.5 mm at the porta hepatis and duodenal papilla levels, respectively in normal dogs weighing less than 15 kg. Dogs suspected to have cholestasis associated with hepatobiliary or pancreatic diseases had significantly larger CBD than that in normal dogs.
Topics: Animals; Cholestasis; Common Bile Duct; Dog Diseases; Dogs; Female; Gallbladder; Male; Tomography, X-Ray Computed; Ultrasonography
PubMed: 29929356
DOI: 10.4142/jvs.2018.19.5.653 -
Annals of the Royal College of Surgeons... Sep 1979Clinical, operative, and conventional radiological criteria may provide insufficient indications for exploration of the common bile duct. The technique of contact...
Clinical, operative, and conventional radiological criteria may provide insufficient indications for exploration of the common bile duct. The technique of contact cholangiography improves the radiographic definition, especially in the obese, and has resulted in more positive choledochotomies and in fewer negative explorations.
Topics: Cholangiography; Common Bile Duct; Humans; Methods
PubMed: 496230
DOI: No ID Found -
The Korean Journal of Gastroenterology... Oct 2020Local and systemic factors, such as diabetes, obesity, and hyperlipidemia, are considered risk factors for the recurrence of choledocholithiasis after successful... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND/AIMS
Local and systemic factors, such as diabetes, obesity, and hyperlipidemia, are considered risk factors for the recurrence of choledocholithiasis after successful endoscopic clearance. Local factors include the presence of bile sludge, common bile duct (CBD) diameter, and CBD angulation. Among them, it is unclear if acute CBD angulation is preferable to the recurrence of a CBD stone.
METHODS
PubMed, EMBASE, CINAHL, the Cochrane Library databases, and google website were searched for randomized controlled trials reported in English and undertaken until August 2019. Meta-analysis was performed on all randomized controlled trials for the recurrence of CBD stones between the patients with acute CBD angulation.
RESULTS
Eight randomized trials (1,776 patients) were identified, and the total recurrent rate of CBD stones was 18.8% (334/1,776). A CBD angle ≤145° was significantly associated with an increased risk of recurrent CBD stone (OR=2.65, p<0.01). In two prospective studies, acute CBD angulation was not proven to be associated with a recurrence (p=0.39).
CONCLUSIONS
Approximately 20% of patients with a CBD stone showed recurrence after the complete clearance of the CBD stone, and a CBD angle ≤145° could increase the risk of recurrence. Overall, a large-scale prospective study should be necessary.
Topics: Cholangiopancreatography, Endoscopic Retrograde; Common Bile Duct; Databases, Factual; Gallstones; Humans; Odds Ratio; Recurrence; Risk Factors
PubMed: 33100315
DOI: 10.4166/kjg.2020.76.4.199 -
Cirugia Y Cirujanos 2022To determine the average value of the diameter of the common bile duct by age group in adult patients without bile duct pathology.
OBJECTIVE
To determine the average value of the diameter of the common bile duct by age group in adult patients without bile duct pathology.
METHOD
A cross-sectional, observational, descriptive and prospective study in adults without bile duct pathology who underwent abdominal ultrasound. The internal diameter of the common bile duct was measured after questioning. In the descriptive analysis, absolute frequencies, percentages, mean and standard deviation were used in the inferential Student's t test and Pearson's correlation.
RESULTS
608 patients without bile duct pathology were included, the mean diameter of the common bile duct was 4.04 ± 1.11 mm; with a minimum of 1.9 mm and a maximum of 8.8 mm. The mean for the population under 30 years was 3.8 ± 0.87, for the 30-39 years group it was 4.27 ± 0.89, for the 40-49 years group it was 4.39 ± 0.83, for the 50-59 years 4.86 ± 1, for the 60-69 years group it was 5.4 ± 0.95, and for those over 70 years it was 6.9 ± 0.8.
CONCLUSIONS
The diameter of the common bile duct in adult patients without biliary pathology is greater at older age.
Topics: Adult; Bile Ducts; Common Bile Duct; Cross-Sectional Studies; Humans; Prospective Studies; Ultrasonography
PubMed: 35944397
DOI: 10.24875/CIRU.20001391 -
Life Sciences Dec 2023Bacterial translocation, defined as the presence of living bacteria or bacterial fragments in both mesenteric lymph nodes or systemic circulation, can cause a severe...
AIMS
Bacterial translocation, defined as the presence of living bacteria or bacterial fragments in both mesenteric lymph nodes or systemic circulation, can cause a severe inflammatory reaction in patients with cirrhosis. This study aimed to compare lipid peroxidation associated with liver damage in different experimental models of bile duct ligation: proximal double ligation and transection versus proximal simple ligation versus sham.
MATERIALS AND METHODS
Sixty-two male rats underwent one of three bile duct surgical interventions: proximal double ligation and transection (n = 22); proximal simple ligation (n = 19); or sham operation (n = 21). We performed microbiological culture of mesenteric lymph nodes; portal and cava blood, spleen and liver cultures; and histological analysis of liver parenchyma. Samples of blood and liver were obtained at laparotomy for malondialdehyde quantification.
KEY FINDINGS
Serum malondialdehyde levels were significantly higher in simple ligature animals (3.7 nmol/mg, standard deviation [SD] 2.1) compared to controls (1.6 nmol/mg SD 0.5; p = 0.001) or double ligature (0.3 nmol/mg SD 0.3; p = 0.001). Liver malondialdehyde levels were significantly higher in animals subjected to double ligation vs controls (9.0 nmol/mg SD 2.8 vs. 1.7 nmol/mg SD 1.0; p = 0.0007) and simple ligature (2.9 nmol/mg SD 2.0; p = 0.0001). Overall incidence of bacterial translocation was similar in simple and double ligatures (22.2 % and 21 % respectively), and significantly higher than in controls.
SIGNIFICANCE
the type of bile duct ligation influences the type and localization of lipid peroxidation, but does not influence the development of bacterial translocation.
Topics: Humans; Rats; Male; Animals; Rats, Sprague-Dawley; Lipid Peroxidation; Liver; Bile Ducts; Common Bile Duct; Ligation; Malondialdehyde
PubMed: 37925139
DOI: 10.1016/j.lfs.2023.122238 -
Cirugia Y Cirujanos 2022Common bile duct pressure (CBDP) after surgical exploration has not been fully detailed. The objective was to describe the changes of CBDP after open surgical...
BACKGROUND
Common bile duct pressure (CBDP) after surgical exploration has not been fully detailed. The objective was to describe the changes of CBDP after open surgical exploration in patients with choledocholithiasis, considering clinical scenarios in remote locations.
MATERIAL AND METHODS
A before-after study was designed. Patients with choledocholithiasis who required an open cholecystectomy with exploration of bile ducts were included in the study. Open cholecystectomy was performed and perioperative T-tube CBDP was registered immediately after the procedure and weekly thereafter, with a 6 week follow-up. Control T-tube cholangiogram was performed at week 6 to exclude residual stones. Data were analyzed with T test for paired samples.
RESULTS
Thirteen patients were included (age range, 17-69 years; 38.69 ± 17.97). Mean CBDP (cm HO) registered were as follows: Initial = 19.5, week 1 = 16.2, week 2 = 14.3, week 3 = 13.0, week 4 = 12.1, week 5 = 11.1, and week 6 = 9.7. There were significant differences shown when comparing week 2 (p = 0.05), week 3 (p = 0.036), week 4 (p = 0.023), week 5 (p = 0.010), and week 6 (p = 0.004) with the initial value.
CONCLUSIONS
CBDP decreases between 2 and 3 post-operative weeks. The use of choledochomanometry is useful in clinical scenarios with no access to imaging or interventionism facilities as in remote populations or rural locations.
Topics: Humans; Adolescent; Young Adult; Adult; Middle Aged; Aged; Common Bile Duct
PubMed: 36480750
DOI: 10.24875/CIRU.21000808 -
Canadian Journal of Surgery. Journal... 2023The recurrence of common bile duct stones and other biliary events after endoscopic retrograde cholangiopancreatography (ERCP) is frequent. Despite recommendations for...
BACKGROUND
The recurrence of common bile duct stones and other biliary events after endoscopic retrograde cholangiopancreatography (ERCP) is frequent. Despite recommendations for early cholecystectomy, intervention during the same admission is carried out inconsistently.
METHODS
We reviewed the records of patients who underwent ERCP for gallstone disease and common bile duct clearance followed by cholecystectomy between July 2012 and June 2022. Patients were divided into 2 groups: the index group underwent cholecystectomy during the same admission and the delayed group was discharged and had their cholecystectomy postponed. Data on demographics and prognosis factors were collected and analyzed.
RESULTS
The study population was composed of 268 patients, with 71 (26.6%) having undergone cholecystectomy during the same admission after common bile duct clearance with ERCP. A greater proportion of patients aged 80 years and older were in the index group than in the delayed group. The American Society of Anesthesiologists score was significantly higher in the index group. There was no significant difference between groups regarding surgical complications, open cholecystectomy and death. The operative time was significantly longer in the delayed group. Among patients with delayed cholecystectomy, 18.3% had at least 1 recurrence of common bile duct stones (CBDS) and 38.6% had recurrence of any gallstone-related events before cholecystectomy. None of these events occurred in the the index group. There was no difference in the recurrence of CBDS and other biliary events after initial diagnosis associated with stone disease.
CONCLUSION
Cholecystectomy during the same admission after common bile duct clearance is safe, even in older adults with comorbidities. Compared with delayed cholecystectomy, it was not associated with adverse outcomes and may have prevented recurrence of biliary events.
Topics: Humans; Aged; Common Bile Duct; Cholangiopancreatography, Endoscopic Retrograde; Hospitalization; Patient Discharge; Cholecystectomy
PubMed: 37734850
DOI: 10.1503/cjs.008322 -
The Turkish Journal of Gastroenterology... Oct 2014Some common bile duct (CBD) stones recur after endoscopic stone extraction. Little information is available on the size and recurrence interval of recurrent symptomatic...
BACKGROUND/AIMS
Some common bile duct (CBD) stones recur after endoscopic stone extraction. Little information is available on the size and recurrence interval of recurrent symptomatic CBD stones or on ways to prevent recurrence.
MATERIALS AND METHODS
Between January 2007 and December 2011, consecutive 481 patients undergoing endoscopic extraction of CBD stones at a single institute were enrolled. We selected 34 patients with recurrent symptomatic CBD stones and 63 patients who were followed up more than five years without recurrence.
RESULTS
The sizes of the CBD stones increased during the recurrences: 10.1±5.2 mm, 13.5±7.3 mm, and 16.8±7.8 mm at the initial presentation, the first recurrence, and the second recurrence, respectively (p=0.016). Among CBD stone recurrences, 50% occurred within 2.3 years, and 80% occurred within 5.3 years. The recurrence group had a smaller proportion of patients under 50 years of age, larger CBD diameters, less histories of more than 10 mm endoscopic papillary large-balloon dilation (EPLBD), and more type I periampullary diverticula, compared with the non-recurrence group (p<0.05). Multivariate analysis revealed that EPLBD more than 10 mm and smaller CBD diameter were independently related to less recurrence of CBD stones (p=0.001 and 0.012, respectively).
CONCLUSION
The sizes of CBD stones increased during recurrences. EPLBD more than 10 mm and smaller CBD diameter were related to less recurrence of CBD stones.
Topics: Age Factors; Aged; Aged, 80 and over; Ampulla of Vater; Catheterization; Common Bile Duct; Dilatation; Diverticulum; Duodenal Diseases; Female; Gallstones; Humans; Male; Middle Aged; Recurrence; Risk Factors; Time Factors
PubMed: 25417612
DOI: 10.5152/tjg.2014.6457 -
Medicine Sep 2020This study aimed to describe a novel puncture and discission with a needle (PDN) method facilitating laparoscopic common bile duct exploration (LCBDE).The clinical data... (Observational Study)
Observational Study
This study aimed to describe a novel puncture and discission with a needle (PDN) method facilitating laparoscopic common bile duct exploration (LCBDE).The clinical data of 81 patients with cholelithiasis or choledocholithiasis who underwent LCBDE with PDN between January, 2017 and December, 2017 were retrospectively analyzed. Time for puncture and discission of the bile duct, blood loss, postoperative complications (such as bile leakage, common bile duct [CBD] strictures, and recurrence of choledocholithiasis), and postoperative hospital stay were recorded to evaluate the safety of the method.PDN was performed in all 81 patients with a 100% surgical success rate. Surgery went smoothly. Neither mortality nor complications associated with PDN (portal vein injury or biliary leakage) were observed. The mean time for puncture and discission of the CBD was 2.4 minutes and the maximum blood loss was 100 mL. CBD strictures or recurrence of choledocholithiasis were not noted after 12 to 24 months of follow-up.LCBDE with PDN is a novel method and has the advantages of reliability, convenience, and efficiency without additional costs or complications.
Topics: Adult; Aged; Aged, 80 and over; Choledocholithiasis; Common Bile Duct; Digestive System Surgical Procedures; Female; Humans; Laparoscopy; Male; Middle Aged; Retrospective Studies; Young Adult
PubMed: 32957359
DOI: 10.1097/MD.0000000000022220