Cawich Shamir O, Griffith Sahle P, Greenidge Charles W, Bonadie Kimon, Mohammed Fawwaz, Padmore Greg M, Algu Tameshwar, Ramcharran Hemraj, Naraynsingh Vijay
Surgery, University of the West Indies, St. Augustine, TTO.
Surgery, Queen Elizabeth Hospital, Bridgetown, BRB.
Cureus. 2023 Aug 4;15(8):e42949. doi: 10.7759/cureus.42949. eCollection 2023 Aug.
Background Common bile duct (CBD) exploration to address choledocholithiasis is not widely practiced in the English-speaking Caribbean. This study sought to determine the frequency of laparoscopic CBD explorations in the English-speaking Caribbean and to document the stone clearance rates and short-term outcomes of this procedure. Methods We accessed records for all practicing laparoscopic surgeons in the English-speaking Caribbean who performed laparoscopic CBD explorations over a 10-year period from January 1, 2013, to June 30, 2023. The following data were extracted retrospectively from patient records: demographic details, operating time, stone clearance rates, retained stone rates, conversions, and complications. All data were analyzed with SPSS version 20 (IBM Corp., Armonk, NY). Results Over the 10-year study period, 35 patients underwent laparoscopic cholecystectomy and synchronous CBD exploration in Barbados, Cayman Islands, Guyana, Grenada, St Lucia, and Trinidad & Tobago. The procedure was performed at low volumes of only 0.7 procedures per surgical team per annum. The conversion rate to open CBD exploration was 13% and when laparoscopic CBD exploration was completed, it resulted in 96.3% stone clearance, 3.7% retained stones, mean hospitalization of two days, 9.7% minor morbidity, and no mortality. Conclusion Laparoscopic CBD exploration is feasible in the resource-poor Caribbean setting, and it yields good results, with 96.3% stone clearance rates, 9.7% minor morbidity, and no mortality. These results are better than those reported in Caribbean literature for stone extraction with endoscopic retrograde cholangiopancreaticography (ERCP).
背景 在讲英语的加勒比地区，用于治疗胆总管结石的胆总管探查术并未广泛开展。本研究旨在确定讲英语的加勒比地区腹腔镜胆总管探查术的频率，并记录该手术的结石清除率和短期结果。方法 我们获取了2013年1月1日至2023年6月30日这10年间在讲英语的加勒比地区进行腹腔镜胆总管探查术的所有执业腹腔镜外科医生的记录。以下数据从患者记录中进行回顾性提取：人口统计学细节、手术时间、结石清除率、残留结石率、中转率和并发症。所有数据均使用SPSS 20版（IBM公司，纽约州阿蒙克）进行分析。结果 在这10年的研究期间，巴巴多斯、开曼群岛、圭亚那、格林纳达、圣卢西亚以及特立尼达和多巴哥共有35例患者接受了腹腔镜胆囊切除术并同期进行胆总管探查。该手术的实施量较低，每个手术团队每年仅进行0.7例手术。转为开腹胆总管探查的比例为13%，完成腹腔镜胆总管探查后，结石清除率为96.3%，残留结石率为3.7%，平均住院天数为2天；轻微并发症发生率为9.7%，无死亡病例。结论 在资源匮乏的加勒比地区开展腹腔镜胆总管探查术是可行的，且效果良好，结石清除率为96.3%；轻微并发症发生率为9.7%，无死亡病例。这些结果优于加勒比地区文献中报道的内镜逆行胰胆管造影术（ERCP）取石结果。
