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|Title:||A predictive nomogram to identify factors influencing the success of a concomitant laparoscopic cholecystectomy with common bile duct exploration for choledocholithiasis||Authors:||Chue K.M.
|Issue Date:||1-Apr-2018||Publisher:||Elsevier B.V.||Citation:||Chue K.M., Aw J.W.B., Chua S.H.M., Chen Z., Iyer S.G., Krishnakumar Madhavan, Kow A.W.C. (2018-04-01). A predictive nomogram to identify factors influencing the success of a concomitant laparoscopic cholecystectomy with common bile duct exploration for choledocholithiasis. HPB 20 (4) : 313-320. ScholarBank@NUS Repository. https://doi.org/10.1016/j.hpb.2017.09.005||Abstract:||Background: Single-staged laparoscopic common bile duct exploration (LCBDE) offers clear benefits in terms of cost and shorter hospitalization stays. However, a failed LCBDE requiring conversion to open surgery is associated with increased morbidity. This study reviewed the factors determining success of LCBDE, and created a predictive nomogram to stratify patients for the procedure. Methods: A retrospective analysis of 109 patients who underwent LCBDE was performed. A nomogram was developed from factors significantly associated with conversion to open surgery and validated. Results: Sixty-two patients underwent a successful LCBDE, while 47 patients required a conversion to open CBDE. The presence of underlying cholangitis (crude OR 2.70, 95% CI: 1.12�6.56, p = 0.017), together with its subsequent interventions, seemed to adversely increase the rate of conversion to open surgery. The predictive factors included in the nomogram for a failed laparoscopic CBDE included prior antibiotic use (adjusted OR (AOR) 2.98, 95% CI: 1.17�7.57, p = 0.022), previous ERCP (AOR 4.99, 95% CI: 2.02�12.36, p = 0.001) and abnormal biliary anatomy (AOR 9.37, 95% CI: 2.18�40.20, p = 0.003). Conclusion: LCBDE is useful for the treatment of choledocholithiasis. However, patients who were predicted to have an elevated risk for open conversion might not be ideal candidates for the procedure. � 2017 International Hepato-Pancreato-Biliary Association Inc.||Source Title:||HPB||URI:||http://scholarbank.nus.edu.sg/handle/10635/146792||ISSN:||1365182X||DOI:||10.1016/j.hpb.2017.09.005|
|Appears in Collections:||Staff Publications|
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