Safety and outcomes of laparoscopic bile duct exploration: a UK-wide multi-centre study (R-ALiCE).
Обработка статьи · этапы, ошибки и управление
Ошибки и ограничения
История · было → стало
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Aroori Somaiah, Andrei Tanase, Nassar Ahmad, Katbeth Tarek Z, MacDonald Scott, Kilpatrick Rhona, Healey Andrew, Zanellato Artur, Clark-Stewart Saskia, Paterson-Brown Simon, Gough Vivienne, Wong Chee Siong, McMurray Laura, Martinez-Isla Alberto, Navaratne Lalin, Senra Fatima, Fehervari Matyas, Morgan Richard, Murali Sreedutt, Abdelkarim Mostafa, Venkatesan Gowtham S, Finlay Ian, Al-Ardah Mahmoud, Rottenburg Hannah, Rasheed Ashraf, Whewell Harriet, Boyce Tamsin, Mercer Stuart, Wilson Iain, Body Samantha, Bhatti Imran, Awan Altaf, Latif Javed, Warnaar Nienke, Suresh Sreelakshmi, Shahmiri Anahita, Croxon Cazz, Robertson Andrew G N, Driscoll Peter J, Clyde Danielle, Marangoni Gabriele, Ahmad Jawad, Fitzpatrick Suzanne, Silva Michael, Abbas Syed Hussain, Ceresa Carlo, Mourad Moustafa, Elmaradny Ahmed, Thomas-Fernandez Katerina, Maliyil Jed, Pellen Michael, Wilkins Alex, Nazir Shahani, Spence Heather, Griffiths Ewen A, Dada Oluwasina, Dabhi Keval, Hoque Mohammed, Garcea Giuseppe, Al Saoudi Tareq, Bahri Suchita, Roked Samir, Adam Streeter, Kuek Dorothy, Sarsam Sera, Dhavala Pooja, Matthew Cramp, Ashwin Danda, R-ALiCE Collaborators
Аннотация
METHODS: The "Retrospective Audit of Laparoscopic Common Bile Duct Exploration (R-ALiCE)", study involved 18 centres across the UK. Adult patients undergoing LCBDE for BDS between 01/01/2015 and 31/12/2019 were included. Patients who underwent LCBDE for non-stone disease and as part of another operation were excluded from the study.
RESULTS: 1,689 patients (68.2% female, median age: 59 years) were included. The open conversion rate was 5% (n = 84). Trans-cystic LCBDE (TC-LCBDE) was attempted in 71.5% (n = 1207) (success rate, 77.6%, n = 937). Trans-choledochal-LCBDE (TD-LCBDE) was performed in 41% (694), with 28.5% being direct-to-trans-ductal explorations. The TD-LCBDE success rate was 93.4% (n = 648). The bile leak rate was 4.4% (n = 75) (61, 8.8% in TD-LCBDE vs. 14,1.5% in the TC-LCBDE, Odds Ratio = 6.76; 95% CI 3.75-12.19; P < 0.001). The retained stone rate was 4.4% (n = 74) (4.1% in TC-LCBDE vs. 4.8% in TD-LCBDE; P = 0.53). Postoperative pancreatitis occurred in 0.9% (n = 15) (0.8% for TC-LCBDE vs. 1% for TD-LCBDE; P = 0.65). The bile duct stricture rate was 0 at 90-day follow-up. The 30-day readmission rate was 7.5% (n = 127). The median length of stay was 3 days (range 2-7). Overall morbidity and Clavien-Dindo grade ≥ III complications rate were 18.7% (n = 316) and 8.8% (n = 149), respectively. The 30-day mortality rate was 0.4% (n = 7).
CONCLUSION: LCBDE is a safe and effective approach for managing BDS, with low rates of severe complications, including bile leak, postoperative pancreatitis, and retained stones. The trans-cystic approach is associated with a lower bile leak rate than the trans-ductal approach.