Document Type

Presentation

Publication Date

8-18-2009

Abstract

This study was undertaken to evaluate the safety and efficacy of LCBDE compared to ERCP. Special focus was palced on the post-operative incidence of pancreatitis after LCBDE in order to demonstrate that the procedure is less likely than ERCP to cause pancreatitis and its associated morbidity and mortality. Methods: A comprehensive chart review was conducted on 140 consecutive patients undergoing LCBDE from January 2001-December 2006. The surgeons in this study are all proficient at LCBDE using both trans-cystic and choledochotomy techniques. Complication rates were analyzed for statistical significance. Clinical evidence and laboratory results including pre and post-operative amylase levels were analyzed to determine the incidence of pancreatitis caused by LCBDE. Results: No cases of clinical pancreatitis were identified in any of these patients after the LCBDE procedure. The post-LCBDE amylase was significantly lower than the pre-LCBDE amylase. One case of post-LCBDE pancreatitis was identified using diagnostic guidelines of serum amylase above 3 times normal (375 U/L), for a total incidence of 0.71% (95% confidence interval 0.018%-3.92%). This incidence is significantly less than the 7-15% incidence reported for ERCP (p=0.00045). Successful stone clearance was accomplished in 96% (n=134)of cases. 19 patients presented with gall stone pancreatitis prior to undergoing LCBDE. In none of these patients was the post-LCBDE amylase level greater than the preoperative level. The most common complications due to LCBDE included a 2.9% (n=4)incidence of bile leakage, a 2.9% (n=4)incidence of T-tube dislodgement, and a 1.4% (n=2) incidence of cellulitis at the drain site. Conclusions: LCBDE is found to be superior to ERCP in terms of the rate of serious complications, particularly that of post-operative pancreatitis. Because of the morbidity and mortality associated with pancreatitis, we conclude that LCBDE should be further investigated as a viable and potentially safer approach to the remediation of choledocholithiasis.

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