Skip to main content
SpringerLink
Log in

Intraoperative cholangiography with filling defects: comparative complication analysis of postoperative transcystic duct (TCD) catheter maintenance

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

This is a retrospective cohort of patients undergoing laparoscopic cholecystectomy with intraoperative cholangiography (IOC) with positive findings for filling defects. We comparatively assessed differences in complication risks for patients that had their cholangiography catheter maintained in its transcystic duct (TCD) position postoperatively. This is a practice proposed to overcome the limited availability of Endoscopic Retrograde Cholangiopancreatography (ERCP) as well as to avoid surgical exploration of the common bile duct.

Methods

Retrospective medical record review of all positive IOC from January 2015 to December 2018 were assessed. Patients’ demographic and perioperative data from the hospital stay period in which the cholecystectomy occurred until the last surgical ambulatory visit for perioperative characteristics were compared between groups (with vs. without TCD catheter). Complications were operationalized using the Clavien-Dindo scale.

Results

Univariate analysis of complications showed a 2.4-fold risk increase in complications (95% CI 1.13–5.1) between comparison groups. Number of ERCPs (18 vs. 30), and MRCPs (5 vs. 17) were not significantly different between maintaining or not the TCD catheter postop, respectively. Stratified analysis followed by exact logistic regression supported the findings that maintaining the TCD catheter postoperatively increased complication rates (OR = 5.34, 95% CI 1.22, 29.83, p = 0.022), adjusting for potential confounders.

Conclusion

The maintenance of the TCD catheter postoperatively did not prove to be effective in significantly reducing the number of ERCP nor associated complications. Also, outcomes inherited from the practice caused adverse events that surpassed its potential benefits. Moreover, expectant follow-up is reasonable for patients with evidence of common bile duct stones, even in setting with limited resource availability. We do not recommend this practice, even in settings where there are limited resources of more modern management of choledocholithiasis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Manning A, Frazee R, Abernathy S, Isbell C, Isbell T, Regner J et al (2017) Protocol-driven management of suspected common duct stones. J Am Coll Surg 224(4):645–649

    Article  Google Scholar 

  2. Gurusamy KS, Giljaca V, Takwoingi Y, Higgie D, Poropat G, Stimac D et al (2015) Endoscopic retrograde cholangiopancreatography versus intraoperative cholangiography for diagnosis of common bile duct stones. Cochrane Database Syst Rev 2:Cd010339

    Google Scholar 

  3. Dasari BV, Tan CJ, Gurusamy KS, Martin DJ, Kirk G, McKie L et al (2013) Surgical versus endoscopic treatment of bile duct stones. Cochrane Database Syst Rev 12:CD003327

    Google Scholar 

  4. Kimura Y, Takada T, Kawarada Y, Nimura Y, Hirata K, Sekimoto M et al (2007) Definitions, pathophysiology, and epidemiology of acute cholangitis and cholecystitis: Tokyo guidelines. J Hepato-Biliary-Pancreat Surg 14(1):15–26

    Article  Google Scholar 

  5. Sun SX, Kulaylat AN, Hollenbeak CS, Soybel DI (2016) Cost-effective decisions in detecting silent common bile duct gallstones during laparoscopic cholecystectomy. Ann Surg 263(6):1164–1172

    Article  Google Scholar 

  6. Ricci C, Pagano N, Taffurelli G, Pacilio CA, Migliori M, Bazzoli F et al (2018) Comparison of efficacy and safety of 4 combinations of laparoscopic and intraoperative techniques for Management of gallstone disease with biliary duct calculi: a systematic review and network meta-analysis. JAMA Surg 153(7):e181167

    Article  Google Scholar 

  7. Pesce A, Piccolo G, La Greca G, Puleo S (2015) Utility of fluorescent cholangiography during laparoscopic cholecystectomy: a systematic review. World J Gastroenterol 21(25):7877–7883

    Article  Google Scholar 

  8. Videhult P, Sandblom G, Rasmussen IC (2009) How reliable is intraoperative cholangiography as a method for detecting common bile duct stones?: A prospective population-based study on 1171 patients. Surg Endosc 23(2):304–312

    Article  Google Scholar 

  9. Ford JA, Soop M, Du J, Loveday BP, Rodgers M (2012) Systematic review of intraoperative cholangiography in cholecystectomy. Br J Surg 99(2):160–167

    Article  CAS  Google Scholar 

  10. Photi ES, El-Hadi A, Brown S, Swafe L, Ashford-Wilson S, Barwell J et al (2017) The routine use of cholangiography for laparoscopic cholecystectomy in the modern era. JSLS 21(3):32–39

    Article  Google Scholar 

  11. O’Donovan AN, O’Sullivan G, Ireland A, FitzGerald E (1997) Prospective trial of the role of fine bore intubation of the cystic duct at the time of operative cholangiography. J Am Coll Surg 184(3):262–264

    PubMed  Google Scholar 

  12. Cotton PB, Lehman G, Vennes J, Geenen JE, Russell RC, Meyers WC et al (1991) Endoscopic sphincterotomy complications and their management: an attempt at consensus. Gastrointest Endosc 37(3):383–393

    Article  CAS  Google Scholar 

  13. Williams E, Beckingham I, El Sayed G, Gurusamy K, Sturgess R, Webster G et al (2017) Updated guideline on the management of common bile duct stones (CBDS). Gut. 66(5):765–782

    Article  Google Scholar 

  14. Kaif M, Agrawal D, Sreenarasimhaiah J (2017) Can clinical factors predict the need for intervention after a positive intraoperative cholangiogram? J Dig Dis 18(7):410–415

    Article  Google Scholar 

  15. Morris S, Gurusamy KS, Sheringham J, Davidson BR (2015) Cost-effectiveness analysis of endoscopic ultrasound versus magnetic resonance cholangiopancreatography in patients with suspected common bile duct stones. PLoS One 10(3):e0121699

    Article  Google Scholar 

  16. Horwood J, Akbar F, Davis K, Morgan R (2010) Prospective evaluation of a selective approach to cholangiography for suspected common bile duct stones. Ann R Coll Surg Engl 92(3):206–210

    Article  Google Scholar 

  17. Enochsson L, Swahn F, Arnelo U, Nilsson M, Lohr M, Persson G (2010) Nationwide, population-based data from 11,074 ERCP procedures from the Swedish registry for gallstone surgery and ERCP. Gastrointest Endosc 72(6):1175–1184, 84.e1-3

    Article  Google Scholar 

  18. Collins C, Maguire D, Ireland A, Fitzgerald E, O’Sullivan GC (2004) A prospective study of common bile duct calculi in patients undergoing laparoscopic cholecystectomy: natural history of choledocholithiasis revisited. Ann Surg 239(1):28–33

    Article  Google Scholar 

  19. Lee TH, Hwang SO, Choi HJ, Jung Y, Cha SW, Chung IK et al (2014) Sequential algorithm analysis to facilitate selective biliary access for difficult biliary cannulation in ERCP: a prospective clinical study. BMC Gastroenterol 14:30

    Article  Google Scholar 

  20. Maple JT, Ben-Menachem T, Anderson MA, Appalaneni V, Banerjee S, Cash BD et al (2010) The role of endoscopy in the evaluation of suspected choledocholithiasis. Gastrointest Endosc 71(1):1–9

    Article  Google Scholar 

  21. DaVee T, Garcia J, Baron TH (2012) Precut sphincterotomy for selective biliary duct cannulation during endoscopic retrograde cholangiopancreatography. Ann Gastroenterol 25(4):291–302

    PubMed  PubMed Central  Google Scholar 

  22. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213

    Article  Google Scholar 

  23. Chisholm PR, Patel AH, Law RJ, Schulman AR, Bedi AO, Kwon RS et al (2019) Preoperative predictors of choledocholithiasis in patients presenting with acute calculous cholecystitis. Gastrointest Endosc 89(5):977–83.e2

    Article  Google Scholar 

  24. Krause TJ, Robertson FM, Liesch JB, Wasserman AJ, Greco RS (1990) Differential production of interleukin 1 on the surface of biomaterials. Arch Surg 125(9):1158–1160

    Article  CAS  Google Scholar 

  25. Bekheit M, Smith R, Ramsay G, Soggiu F, Ghazanfar M, Ahmed I (2019) Meta-analysis of laparoscopic transcystic versus transcholedochal common bile duct exploration for choledocholithiasis. BJS Open 3(3):242–251

    Article  CAS  Google Scholar 

  26. Hakuta R, Hamada T, Nakai Y, Oyama H, Kanai S, Suzuki T et al (2020) Natural history of asymptomatic bile duct stones and association of endoscopic treatment with clinical outcomes. J Gastroenterol 55(1):78–85

    Article  Google Scholar 

  27. Singh G, Gupta PC, Sridar G, Katariya RN (2000) Role of selective intra-operative cholangiography during cholecystectomy. Aust N Z J Surg 70(2):106–109

    Article  CAS  Google Scholar 

  28. Snow LL, Weinstein LS, Hannon JK, Lane DR (2001) Evaluation of operative cholangiography in 2043 patients undergoing laparoscopic cholecystectomy: a case for the selective operative cholangiogram. Surg Endosc 15(1):14–20

    Article  CAS  Google Scholar 

Download references

Acknowledgements

We thank Dr. Martina Pavlicova (Columbia University Medical Center) for statistical and methodological advice.

Author information

Authors and Affiliations

  1. Universidade Federal de Ciências da Saúde, Programa de Pós-Graduação Ciências da Saúde, R Sarmento Leite 245, Porto Alegre, RS, 90050-170, Brazil

    Thiago B de Araujo, Geraldo P Jotz & Rafaela A Mantelli

  2. Hospital de Clínicas de Porto Alegre, Serviço de Cirurgia Geral, Porto Alegre, RS, Brazil

    Thiago B de Araujo, Camila H Zaki, Vinicius F Fernandes, Guilherme G Pretto, Bernardo S Volkweis, Carlos Otavio Corso & Leandro T Cavazzola

Authors
  1. Thiago B de Araujo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Geraldo P Jotz
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Camila H Zaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Rafaela A Mantelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Vinicius F Fernandes
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Guilherme G Pretto
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Bernardo S Volkweis
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Carlos Otavio Corso
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Leandro T Cavazzola
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Thiago B de Araujo.

Ethics declarations

Disclosure

Drs. Thiago Bozzi de Araujo, Geraldo Pereira Jotz, Camila Horr Zaki, Rafaela Avallone Mantelli, Vinicius Fornari Fernandes, Guilherme Gonçalves Pretto, Bernardo Silveira Volkweis, Carlos Otavio Corso, and Leandro Totti Cavazzola have no conflicts of interests or financial ties to disclose.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

“Transcystic duct catheter maintenance analysis”

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

de Araujo, T.B., Jotz, G.P., Zaki, C.H. et al. Intraoperative cholangiography with filling defects: comparative complication analysis of postoperative transcystic duct (TCD) catheter maintenance. Surg Endosc 35, 6438–6448 (2021). https://doi.org/10.1007/s00464-020-08133-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-020-08133-y

Keywords

Search

Navigation