Choledocholithiasis without cholecystolithiasis, after endoscopic retrograde cholangiopancreatography follow-up without cholecystectomy

Year 2021, Volume: 13 Issue: 1, 68 - 73, 11.03.2021

Bahtiyar Muhammedoğlu , Eyüp Pircanoğlu Serkan Torun

https://doi.org/10.18521/ktd.714664

Abstract

Objective: The widespread use of imaging methods increases the diagnosis and incidence of cholelithiasis. In recent years, the management of patients with cholelithiasis has improved significantly owing to significant advances in the surgical and endoscopic intervention.

Materials and Methods: Between February 2015 and January 2018, the data of patients who underwent ERCP at our institution were collected prospectively and analyzed retrospectively. Forty-four patients included in the study were patients with choledocholithiasis without stones in the GB.

Results: The mean age of 52 subjects (group A) included in the study was 64.83 ± 17.06, of which 23 (44.2%) were <65 years old and 29 (55.8%) were ≥65 years old. Twenty-four (46.2%) women and twenty-eight (53.8%) men were included in the study. Malignancy was suspected in 6 (11.5%) patients and no suspicion of malignancy was confirmed after Endoscopic Retrograde Cholangio-Pancreatography (ERCP) procedure. In group A, 14 patients (26.9%) required a second ERCP, while in group B, the number of patients requiring a second ERCP was 163 (21.3%). The mean length of hospital stay in group A and group B patients was 5.29 ± 3.38 and 6.29 ± 5.39, respectively, and the average cost was 474 $ ± 286 $ and 564 $ ± 664 $, respectively, with no statistical difference between the groups.

Conclusions: In conclusion, we think that in patients with secondary or primary choledochal stones without gallstones and with functional GB might be following up without cholecystectomy after the stone is removed from the bile duct by ERCP

Keywords

Gallbladder, Laparoscopic Cholecystectomy, cholelithiasis

Supporting Institution

No funding was received for this manuscript

Project Number

No funding was received for this manuscript

Thanks

Acknowledgement: Non

Kolelitiazis Olmadan Gelişen Koledokolitiazis Hastalarının Endoskopik Retrograd Kolanjiopankreatografi Sonrası Kolesistektomisiz Takibi

Abstract

Amaç: Görüntüleme yöntemlerinin yaygın kullanılması kolelitiazis ve koledokolitiazis tanısını ve görülme sıklığı artırmaktadır.Buna karşılık, bu yaygın hastalığın yönetiminde cevap gerektiren bazı sorular vardır.

Gereç Ve Yöntem: Şubat 2014 ile Ocak 2018 arasındaki dönemde kurumumuzda endoskopik retrograd kolanjiopankreatografi (ERCP) yapılan hastaların verileri prospektif olarak toplandı ve retroprospektif olarak analiz edildi. Çalışmaya safra kesesinde (SK) taş olmayıp koledokta taşı olan 52 hasta dâhil edildi. Safra kesesinin değerlendirilmesi ise abdomen USG ile gerçekleştirildi. ERCP, laparoskopik kolesistektomi ve hasta takibi tek cerrah tarafından gerçekleştirildi.

Bulgular: Çalışmaya dâhil edilen SK taşı olmadan koledok taşı olan hastaların (grup A) yaş ortalaması 64.83 ± 17.06 olup bunlardan 23 (%44,2 ) i <65 yaş altında ve 29 (%55,8 ) ≥65yaşından yaşlı idi. Diğer nedenlerle ERCP yapılan hastalar grup B olarak belirlendi. Grup A hastalarında yaş ortalaması grup B ye göre anlamlı olarak daha yüksek bulundu (P=0.001). Dört hastaya safra kesesinde tekrar taş oluşumu nedeniyle ve üç hastaya erken dönemde gelişen akut kolesistit nedeniyle laparoskopik kolesistektomi gerçekleştirildi. Ulaşılamayan ve takip kriterlerine uymayan hastalar çalışmadan çıkarıldı, kalan 30 hastanın rutin poliklinik ziyaretlerinde (4-24 ay takip) safra kesesinde taş tespit edilemedi ve rutin poliklinik kontrollerinin devamı önerildi.

Sonuç: Safra kesesinde taşı olmayıp sekonder veya primer koledok taşı olan hastalarda, ERCP ile taş safra kanalından çıkarıldıktan sonra asemtomatik ve fonksiyonel safra kesesi olan hastalar kolesistektomi yapılmadan takip edilebilir.

Keywords

safra kesesi, kolelitiasis, laparoskopik kolesistektomi

Project Number

No funding was received for this manuscript

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