title: Comparison of emergent versus elective laparoscopic common bile duct exploration for patients with or without nonsevere acute cholangitis complicated with common bile duct stones.
abstract: BACKGROUND
  Laparoscopic common bile duct exploration (LCBDE) has already been established for the treatment of patients with common bile duct stones (CBDS) in elective situations. However, the effect of emergent LCBDE on those patients with nonsevere acute cholangitis has not been assessed. The aim of this study was to evaluate the effect of emergent LCBDE on patients with nonsevere acute cholangitis complicated with CBDS.
  
  
  METHODS
  Seventy-two patients with CBDS admitted from January 2009 to December 2012 were included for this retrospective study. LCBDE of transductal approach for CBDS was performed to all patients. Thirty-seven patients underwent emergent LCBDE for nonsevere acute cholangitis and 35 patients underwent elective LCBDE. Duration of the procedure, complications, retained stone of bile duct, hospital stay, and total charges were compared between the two groups. In addition, the characteristics of patients underwent emergent LCBDE were also compared before and after surgery.
  
  
  RESULTS
  There was no significant difference with regard to the diameter of common bile duct and number of CBDS from imaging and/or operative findings between the two groups. There was no conversion to open common bile duct exploration, no major bile duct injuries, and no mortality in both the group of patients. There was no significant difference in patients with or without acute or chronic cholecystitis, duration of surgery, overall hospital stay (16.41 ± 1.03 versus 14.54 ± 0.94, P > 0.05), and total charges (18,603 ± 1774.64 versus 14,951 ± 1257.09 Yuan in renminbi, P > 0.05) between the two groups. Four cases with retained stones were found in patients with emergent LCBDE and two in elective LCBDE patients. There were four cases of biliary leak in patients with emergent LCBDE and three cases in elective LCBDE group, respectively. However, there was no statistical difference between the two groups. The biliary leak was cured postoperatively after drainage. Control of septic symptoms was achieved in all patients after emergent LCBDE.
  
  
  CONCLUSIONS
  Our data indicated that emergent LCBDE is as safe and effective as elective LCBDE for the treatment of patients with nonsevere acute cholangitis complicated with CBDS.
authors.affiliation: Department of General Surgery, Laparoscopic Surgical Center, Beijing Shijitan Hospital, Capital Medical University, Haidian District, Beijing, China. Electronic address: binbinzhu99@hotmail.com.
authors.forename: Bin
authors.initials: B
authors.lastname: Zhu
authors.affiliation: Department of General Surgery, Laparoscopic Surgical Center, Beijing Shijitan Hospital, Capital Medical University, Haidian District, Beijing, China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Department of General Surgery, Laparoscopic Surgical Center, Beijing Shijitan Hospital, Capital Medical University, Haidian District, Beijing, China.
authors.forename: Ke
authors.initials: K
authors.lastname: Gong
authors.affiliation: Department of General Surgery, Laparoscopic Surgical Center, Beijing Shijitan Hospital, Capital Medical University, Haidian District, Beijing, China.
authors.forename: Yiping
authors.initials: Y
authors.lastname: Lu
authors.affiliation: Department of General Surgery, Laparoscopic Surgical Center, Beijing Shijitan Hospital, Capital Medical University, Haidian District, Beijing, China.
authors.forename: Yu
authors.initials: Y
authors.lastname: Ren
authors.affiliation: Department of General Surgery, Laparoscopic Surgical Center, Beijing Shijitan Hospital, Capital Medical University, Haidian District, Beijing, China.
authors.forename: Xiaopu
authors.initials: X
authors.lastname: Hou
authors.affiliation: Department of medicine, Division of Gastroenterology, Hepatology and Nutrition, University of Louisville School of Medicine, Louisville, Kentucky.
authors.forename: Ming
authors.initials: M
authors.lastname: Song
authors.affiliation: Department of General Surgery, Laparoscopic Surgical Center, Beijing Shijitan Hospital, Capital Medical University, Haidian District, Beijing, China. Electronic address: nengweizhang@hotmail.com.
authors.forename: Nengwei
authors.initials: N
authors.lastname: Zhang
mesh_terms: D000208:Acute Disease; D000368:Aged; D002761:Cholangitis / Q000601:surgery*; D042883:Choledocholithiasis / Q000601:surgery*; D003135:Common Bile Duct / Q000601:surgery*; D017558:Elective Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D012720:Severity of Illness Index
keywords: Acute cholangitis; Choledocholithiasis; Choledochotomy; Laparoscopic common bile duct exploration; Technology assessment