Predictors of hyperamylasemia in patients with cholecystolithiasis after laparoscopic cholecystolithotomy with intraoperative dosed endoscopic papillotomy
DOI:
https://doi.org/10.14739/2310-1210.2018.4.137093Keywords:
cholecystolithiasis, laparoscopic cholecystolithotomy, intraoperative endoscopic dosed papillotomy, transient hyperamylasemia, prognosisAbstract
The purpose of the work is to improve the early and long-term results of patients with cholecystolithiasis treatment by supplementing cholecystolithotomy with one-stage intraoperative dosed endoscopic papillosphincterotomy (EPST) and predictors of increased risk of transient hyperamylasemia after EPST identification.
Material and methods. 33 patients with cholecytholithiasis were involved in the study, the average age was 46.82 ± 13.02 years, women 27 (82 %), body mass index 28.56 ± 5.85 kg/m2. We studied intraoperative, early postoperative complications and long-term results. The follow-up period of patients with cholecystolithiasis after cholecystolithotomy with intraoperative dosed endoscopic papillotomy was 1424 days (3.9 years), median follow-up – 467 days. The odds ratio was calculated using logistic regression analysis.
Results. Intraoperative and early postoperative complications were not observed. During the endoscopic papillotomy and in the early postoperative period no serious complications (duodenal perforations, bleeding, pancreatitis (pancreatic necrosis)) were observed. Transient hyperamylasemia occurred in 4 (12.12 %) out of the 33 patients with choledocholithiasis who were performed laparoscopic cholecystolithotomy with intraoperative papillotomy in the first day after surgery. According to the logistic regression, the choledochus ascending diameter increase more than4.2 mm (HS = 2.31; 95% CI 1.02–6.11; P = 0.0483) is associated with transient amylasemia. One case of acute non-calculous cholecystitis requiring the surgical intervention (laparoscopic cholecystectomy) was registered during 3.9 years of follow-up. Recurrence of cholecystocholedocholithiasis and major duodenal papilla stenosis occurred in no case.
Conclusions. Laparoscopic cholecystolithotomy supplemented with one-stage intraoperative dosed endoscopic papillotomy performed according to absolute indications, are safe and highly effective surgical intervention, which allows preserving the gall bladder, restoring its motor-evacuator and concentration functions, and preventing recurrence of cholecystocholedocholithiasis by restoring bile outflow to the duodenum. Transient hyperamylasemia occurred in the first day after operation in 12.12 % (4/33) patients with cholecystolithiasis, who were performed laparoscopic cholecystolithotomy with intraoperative endoscopic papillotomy. The predictor of transient hyperamylasemia after cholecystolithotomy with intraoperative dosed endoscopic papillotomy in patients with cholecystolithiasis is the ascending choledochus diameter increase more than4.2 mm (VS = 2.31; 95 % CI 1.02–6.11; P = 0.0483).
References
Akashi, R., Kiyozumi, T., Tanaka, T., Sakurai, K., Oda, Y., & Sagara, K. (2002) Mechanism of pancreatitis caused by ERCP. Gastrointest. Endosc., 55(1), 50–54. doi: 10.1067/mge.2002.118964.
Bergman, J., van Berkel, A. M., Bruno, M., Fockens, P., Rauws, E., Tijssen, J., et al. (2001) Is endoscopic balloon dilation for removal of bile duct stones associated with an increased risk for pancreatitis or a higher rate of hyperamylasemia? Endoscopy, 33(5), 416–420. doi: 10.1055/s-2001-14424.
Chen, J.-J., Wang, X.-M., Liu, X.-Q., Wen, Li, Mo, Dong, Zong-Wu, Suo, et al. (2014) Risk factors for post-ERCP pancreatitis: a systematic review of clinical trials with a large sample size in the past 10 years. European Journal of Medical Research, 19(1), 26. doi: 10.1186/2047-783X-19-26.
Fisher, M., Spilias, D. C., & Tong, L. K. (2008) Diarrhoea after laparoscopic cholecystectomy: incidence and main determinantsю ANZ J. Surg., 78(6), 482–486. doi: 10.1111/j.1445-2197.2008.04539.x.
Freeman, M. L., Nelson, D. B., Sherman, S., Haber, G. B., Herman, M. E., Dorsher, P. J., et al. (1996) Complications of endoscopic biliary sphincterotomy. N. Engl. J. Med., 335(13), 909–919. doi: 10.1056/NEJM199609263351301.
Masci, E., Mariani, A., Curioni, S., & Testoni, P. A. (2003) Risk factors for pancreatitis following endoscopic retrograde cholangiopancreatography: a meta-analysis. Endoscopy, 35(10), 830–834. doi: 10.1055/s-2003-42614.
Sai, J. K., Suyama, M., Kubokawa, Y., & Watanabe, S. (2008) Diagnosis of mild chronic pancreatitis (Cambridge classification): comparative study using secretin injection-magnetic resonance cholangiopancreatography and endoscopic retrograde pancreatography. World J. Gastroenterol., 14(8), 1218–1221. doi: 10.3748/wjg.14.1218.
Simmons, D., Petersen, B., Gostout, C., Levy, M., Topazian, M., & Baron, T. (2008) Risk of pancreatitis following endoscopically placed large-bore plastic biliary stents with and without biliary sphincterotomy for management of postoperative bile leaks. Surg Endosc., 22(6), 1459–1463. doi: 10.1007/s00464-007-9643-8.
Testoni, P. (2004) Pharmacological prevention of post-ERCP pancreatitis: The facts and the fiction. JOP J. Pancreas (Online), 5, 171–178.
Ye, L., Liu, J., Tang, Y., Yan, J., Tao, K., Wan, C., & Wang, G. (2015) Endoscopic minimal invasive cholecystolithotomy vs laparoscopic cholecystectomy in treatment of cholecystolithiasis in China: a meta-analysis. Int. J. Surg., 13, 227–238. doi: 10.1016/j.ijsu.2014.12.014.
Zhang, Y., Peng, J., Li, X., & Liao, M. (2016) Endoscopic-Laparoscopic Cholecystolithotomy in Treatment of Cholecystolithiasis Compared With Traditional Laparoscopic Cholecystectomy. Surg. Laparosc. Endosc. Percutan. Tech., 26(5), 377–380. doi: 10.1097/SLE.0000000000000305.
Kanikovsky, O. Ye., Bondarchuk, O. I., Karyi, Ya. V., Babiychuk, Ye. V., & Pavlyk, I. V. (2014) Khirurhichna taktyka pry likuvanni uskladnenykh form zhovchnokamianoi khvoroby u khvorykh pokhyloho i starechoho viku [Surgical tactics in treatment of complicated forms of cholelithiasis in elderly and senile patients]. Ukrainskyi zhurnal khirurhii, 2(25), 63–66. [in Ukrainian].
Klimenko, V. M., Syvolap, D. V., & Tertyshniy, S. I. (2017) Morfologichni osoblyvosti velykoho duodenalnoho sosochka u khvorykh na kholelitiaz [Morphological features of the major duodenal papilla in patients with cholelithiasis]. Pathologia, 14(3), 271–275. doi: 10.14739/2310-1237. 2017.3.118317. [in Ukrainian].
Krasilnikov, D. M., Safin, R. Sh., Vasilev, D. Z., Zakharova, A. V., Mirgasimova, D. M., & Yusupova, A. F. (2012) Profilaktika oslozhnenij posle endoskopicheskoj retrogradnoj pankreatoholangiografiyi i papillosfinkterotomii [Prevention of complications after endoscopic retrograde cholangiopancreatography and papillosphincterotomy]. Kazanskij medicinskij zhurnal, 93(4), 597–601. [in Russian].
Kutovoy, A., Rodinskaya, G., & Balyk, D. (2017) Maloinvazivnye i e'ndovideokhirurgicheskie tehnologii v diagnostike i lechenii holedoholitiaza [Minimally-invasive and endovideosurgical technologies in diagnosis and treatment of choledocholithiasis]. Medychni perspektyvy, 22(3), 41–45. [in Russian]. https://doi.org/10.26641/2307-0404.2017.3.111924.
Mandrikov, V. V. (2016) Transpapillyarnaya e'ndoskopicheskaya khirurgiya biliarnoj i pankreaticheskoj gipertenzii (tehnicheskie i takticheskie aspekty) (Dis… dokt. med. nauk). [Transpapillary endoscopic surgery of biliary and pancreatic hypertension (technical and tactical aspects). Dr. med. sci. diss.]. Volgograd. [in Russian].
Nazarenko, P. M., Nazarenko, D. P., Kanischev, Yu. V., & Samgina, T. A. (2016) Sravnitel`nye rezul`taty primeneniya anterogradnoj i tradicionnoj papillosfinkterotomii pri ustranenii holedoholitiaza [Comparative results of antegrade and conventional papillosphincterotomy for]. E'ndoskopicheskaya khirurgiya, 22(4), 25–29. [in Russian]. doi: 10.17116/endoskop201622425-29.
Nikulenkov, S. Yu., & Makarov, Yu. A. (2003) Lechenie holedoholitiaza i papillostenoza s ispol'zovaniem razlichnykh sposobov papillosfinkterotomii [Treatment of choledocholithiasis and papillostenosis using various methods of papillosphincterotomy]. Annaly khirurgicheskoj gepatologii, 8(2), 332–333. [in Russian].
Nichitaylo, M. Ye., Ogorodnik, P. V., & Deynichenko, A. G. (2013) Mіnі-іnvazivnaya khіrurgіya dobrokachestvennoj obstrukcіi distal'nogo otdela obschego zhelchnogo protoka [Minimally invasive surgery of benign obstruction of distal common bile duct]. Ukrainskyi zhurnal khirurhii, 3(22), 45–49. [in Ukrainian].
Prokof'eva A.V., P.M. Nazarenko, B.S. Kovalenko, A. A. Kopylov (2013) Sovershenstvovanie izvestnykh maloinvazivnykh sposobov razresheniya kholedokholitiaza i stenoza BSDK [Perfection of known minimally invasive methods for resolving choledocholithiasis and stenosis of BDDC]. Nauchnye vedomosti Belgorodskogo gosudarstvennogo universiteta. Seriya: Medicina. Farmaciya, 24, 25(168), 122–126. [in Russian].
Tarasenko, S. V., Briantsev, E. M., Marakhovsky, S. L., & Kopeikin, A. A. (2010) Oslozhneniya e'ndoskopicheskikh transpapillyarnykh vmeshatel'stv u bol'nykh dobrokachestvennymi zabolevaniyami zhyolchnykh protokov [Complications of Endoscopic Transpapillary Interventions in Bile Duct Benign Disease Patients]. Annaly khirurgicheskoj gepatologii, 15(1), 21–26. [in Russian].
Downloads
How to Cite
Issue
Section
License
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access)
