title: Laparoscopic transcystic exploration for single-stage management of common duct stones and acute cholecystitis.
abstract: BACKGROUND
  Common bile duct (CBD) stones are found in 10% of patients who undergo elective laparoscopic surgery for gallstone disease and in 10-20% of patients who present with acute cholecystitis (AC). For the latter, the role of laparoscopic transcystic exploration of the common duct (LTCE) as part of a single-stage procedure is still unknown.
  
  
  METHODS
  This study, based on a "laparoscopy first" policy, included 201 subjects with cholecystocholedocholithiasis: 104 underwent a scheduled laparoscopic surgery (group A), and 97 where admitted for AC and had urgent laparoscopy (group B). Group B patients were significantly older (68.4 vs. 62.1 years; P = 0.0045), had a higher proportion of women (56% vs. 41%; P = 0.0345), and included more patients in the ASA III-IV class (39% vs. 21%; P = 0.0006). LTCE was performed by using basket-wired catheters. CBD clearance, operating time, conversion rate, morbidity and mortality, postoperative hospital stay, readmission, and residual CBD stones were the main outcome measures.
  
  
  RESULTS
  Clearance of CBD was obtained in 84% of patients of group A and in 80% of patients of group B (P = not significant). Time spent in the operating room was longer for group B (175 vs. 141 min; P = 0.0003). There were no significant differences for postoperative hospital stay (group A 4.9 vs. group B 5.2 days), readmission rate (3.7% vs. 3.7%), and residual CBD stones (2.8% vs. 3.1%). Need to convert and morbidity occurred more frequently in group B (11.7% vs. 4.6% and 28.7% vs. 16.8%, respectively), but differences were not significant. In group A, one patient died from MOFS.
  
  
  CONCLUSIONS
  LTCE has proved to be a simple technique with a high yield of CBD clearance in the acute setting. Courses are comparable to those observed for the same procedure in elective surgery despite the fact that patients with AC are more at risk for drawbacks.
authors.affiliation: Department of Surgery, University of Pisa Medical School, Pisa, Italy. m.chiarugi@dc.med.unipi.it
authors.forename: Massimo
authors.initials: M
authors.lastname: Chiarugi
authors.forename: Christian
authors.initials: C
authors.lastname: Galatioto
authors.forename: Luigi
authors.initials: L
authors.lastname: Decanini
authors.forename: Adolfo
authors.initials: A
authors.lastname: Puglisi
authors.forename: Piero
authors.initials: P
authors.lastname: Lippolis
authors.forename: Chiara
authors.initials: C
authors.lastname: Bagnato
authors.forename: Sonia
authors.initials: S
authors.lastname: Panicucci
authors.forename: Marco
authors.initials: M
authors.lastname: Pelosini
authors.forename: Pietro
authors.initials: P
authors.lastname: Iacconi
authors.forename: Massimo
authors.initials: M
authors.lastname: Seccia
mesh_terms: D000368:Aged; D002760:Cholangiopancreatography, Endoscopic Retrograde; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D041881:Cholecystitis, Acute / Q000601:surgery*; D042883:Choledocholithiasis / Q000601:surgery*; D005260:Female; D006801:Humans; D041781:Jaundice, Obstructive / Q000209:etiology / Q000601:surgery; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome