Gallego Vela Alberto, Martínez Baena Darío, Lorente Herce José Manuel, Jiménez Riera Granada, Parra Membrives Pablo
General and Digestive Surgery Department, Hepato-Biliary and Pancreatic Surgery Unit, Valme University Hospital, Ctra. de Cádiz Km548.9. 41014, Seville, Spain.
Department of Surgery, University of Seville, Seville, Spain.
Surg Endosc. 2025 Feb;39(2):1227-1233. doi: 10.1007/s00464-024-11488-1. Epub 2024 Dec 30.
Choledocholithiasis is a common clinical condition that may present with severe complications such as acute cholecystitis or cholangitis, requiring treatment on an emergency setting. This situation is frequently managed following an endoscopic approach by ERCP. However, access to emergent endoscopic biliary decompression is lacking in most centers. In addition, experience in laparoscopic common bile duct exploration (LCBDE) in elective patients is increasing revealing good outcomes. This study analyzes the outcomes of LCBDE management of choledocholithiasis performed on an emergency setting (ELCBDE).
We performed a descriptive, prospective, single-center study of patients undergoing ELCBDE from January 2020 to December 2023. Demographic, clinical, and surgical variables were recorded. Postoperative complications (Dindo-Clavien), the success of stone clearance, and the occurrence of bile leaks (ISGLS) were also documented. Recurrence of choledocholithiasis and the association between severe complications and Charlson Comorbidity Index (CCI) were analyzed.
A total of 31 patients were included. Median age was of 78 years. The transductal (TD) approach was employed in all cases without conversion to open surgery. The median CCI was 4. Intraoperative cholangiography was performed in 19.4% of cases and over 4 stones were extracted in 35.5% of the patients. Primary closure of the choledochotomy was achieved in 93.5% of patients. Severe complications (DindoClavien ≥ 3) occurred in 6.5% of patients. There were no reintervention or technique related deaths. Stone recurrence was not detected. The mean hospital stay was 4 days. Neither CCI nor advanced age was significantly associated with severe complications development (p > 0.05).
ELCBDE plus LC is an effective and safe procedure associated with low morbidity and mortality rates. Patients with a high CCI or advanced age should not be discarded for emergent laparoscopic approach. Our results support the choice of ELCBDE as a primary option in the emergency management of choledocholithiasis.
胆总管结石是一种常见的临床病症，可能会出现严重并发症，如急性胆囊炎或胆管炎，需要在紧急情况下进行治疗。这种情况通常通过内镜逆行胰胆管造影术（ERCP）的内镜方法进行处理。然而，大多数中心缺乏紧急内镜下胆道减压的途径。此外，择期患者的腹腔镜胆总管探查术（LCBDE）经验不断增加，显示出良好的效果。本研究分析了在紧急情况下进行的LCBDE治疗胆总管结石的结果（紧急LCBDE）。
我们对2020年1月至2023年12月接受紧急LCBDE的患者进行了一项描述性、前瞻性、单中心研究。记录了人口统计学、临床和手术变量。还记录了术后并发症（Dindo-Clavien分级）、结石清除成功率和胆漏发生率（国际肝脏外科研究组分级）。分析了胆总管结石的复发情况以及严重并发症与Charlson合并症指数（CCI）之间的关联。
共纳入31例患者。中位年龄为78岁。所有病例均采用经胆管途径（TD），未转为开放手术。中位CCI为4。19.4%的病例进行了术中胆管造影，35.5%的患者取出了4颗以上的结石。93.5%的患者实现了胆总管切开的一期缝合。6.5%的患者发生了严重并发症（Dindo-Clavien分级≥3级）。没有再次干预或与技术相关的死亡。未检测到结石复发。平均住院时间为4天。CCI和高龄均与严重并发症的发生无显著关联（p>0.05）。
紧急LCBDE联合腹腔镜胆囊切除术（LC）是一种有效且安全的手术，发病率和死亡率较低。CCI高或高龄的患者不应被排除在紧急腹腔镜手术之外。我们的结果支持将紧急LCBDE作为胆总管结石紧急处理的主要选择。
