An analysis of omitting biliary tract imaging in 668 subjects admitted to an acute care surgery service with biochemical evidence of choledocholithiasis

Andrew J. Riggle, Michael W Cripps, Laindy Liu, Madhu Subramanian, Paul A Nakonezny, Steven E Wolf, Herbert Phelan

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background No consensus exists for the timing and utility of biliary imaging in patients with preoperative concern for choledocholithiasis. Methods Admissions to an acute care surgery service with evidence of choledocholithiasis undergoing same-admission cholecystectomy without preoperative or intraoperative imaging were identified. One-way analysis of variance on the log-transformed outcomes, with the Tukey-Kramer multiple comparison procedure, were used to compare means between groups. Results A total of 668 patients with elevated but downtrending liver enzymes underwent cholecystectomy without preoperative or intraoperative imaging. Thirty-eight patients (5.7%) had postoperative biliary imaging, of whom 22 (3.3%) had definite choledocholithiasis. One case of postoperative cholangitis occurred which required readmission and endoscopic retrograde cholangiopancreatography with no long-term morbidity. Presenting liver enzymes were significantly higher in the group found to have retained stones postoperatively than those without retained stones. Conclusions Patients presenting with biochemical evidence of choledocholithiasis who downtrend preoperatively can be safely managed by cholecystectomy with omission of biliary tract imaging.

Original languageEnglish (US)
Pages (from-to)1140-1146
Number of pages7
JournalAmerican Journal of Surgery
Volume210
Issue number6
DOIs
StatePublished - Dec 1 2015

Fingerprint

Choledocholithiasis
Biliary Tract
Cholecystectomy
Cholangitis
Endoscopic Retrograde Cholangiopancreatography
Liver
Enzymes
Analysis of Variance
Morbidity

Keywords

  • Choledocholithiasis
  • ERCP
  • Intraoperative cholangiogram
  • Liver function tests

ASJC Scopus subject areas

  • Surgery

Cite this

An analysis of omitting biliary tract imaging in 668 subjects admitted to an acute care surgery service with biochemical evidence of choledocholithiasis. / Riggle, Andrew J.; Cripps, Michael W; Liu, Laindy; Subramanian, Madhu; Nakonezny, Paul A; Wolf, Steven E; Phelan, Herbert.

In: American Journal of Surgery, Vol. 210, No. 6, 01.12.2015, p. 1140-1146.

Research output: Contribution to journalArticle

@article{d396d55993e9423c9ee8928cb91128a2,
title = "An analysis of omitting biliary tract imaging in 668 subjects admitted to an acute care surgery service with biochemical evidence of choledocholithiasis",
abstract = "Background No consensus exists for the timing and utility of biliary imaging in patients with preoperative concern for choledocholithiasis. Methods Admissions to an acute care surgery service with evidence of choledocholithiasis undergoing same-admission cholecystectomy without preoperative or intraoperative imaging were identified. One-way analysis of variance on the log-transformed outcomes, with the Tukey-Kramer multiple comparison procedure, were used to compare means between groups. Results A total of 668 patients with elevated but downtrending liver enzymes underwent cholecystectomy without preoperative or intraoperative imaging. Thirty-eight patients (5.7{\%}) had postoperative biliary imaging, of whom 22 (3.3{\%}) had definite choledocholithiasis. One case of postoperative cholangitis occurred which required readmission and endoscopic retrograde cholangiopancreatography with no long-term morbidity. Presenting liver enzymes were significantly higher in the group found to have retained stones postoperatively than those without retained stones. Conclusions Patients presenting with biochemical evidence of choledocholithiasis who downtrend preoperatively can be safely managed by cholecystectomy with omission of biliary tract imaging.",
keywords = "Choledocholithiasis, ERCP, Intraoperative cholangiogram, Liver function tests",
author = "Riggle, {Andrew J.} and Cripps, {Michael W} and Laindy Liu and Madhu Subramanian and Nakonezny, {Paul A} and Wolf, {Steven E} and Herbert Phelan",
year = "2015",
month = "12",
day = "1",
doi = "10.1016/j.amjsurg.2015.06.031",
language = "English (US)",
volume = "210",
pages = "1140--1146",
journal = "American Journal of Surgery",
issn = "0002-9610",
publisher = "Elsevier Inc.",
number = "6",

}

TY - JOUR

T1 - An analysis of omitting biliary tract imaging in 668 subjects admitted to an acute care surgery service with biochemical evidence of choledocholithiasis

AU - Riggle, Andrew J.

AU - Cripps, Michael W

AU - Liu, Laindy

AU - Subramanian, Madhu

AU - Nakonezny, Paul A

AU - Wolf, Steven E

AU - Phelan, Herbert

PY - 2015/12/1

Y1 - 2015/12/1

N2 - Background No consensus exists for the timing and utility of biliary imaging in patients with preoperative concern for choledocholithiasis. Methods Admissions to an acute care surgery service with evidence of choledocholithiasis undergoing same-admission cholecystectomy without preoperative or intraoperative imaging were identified. One-way analysis of variance on the log-transformed outcomes, with the Tukey-Kramer multiple comparison procedure, were used to compare means between groups. Results A total of 668 patients with elevated but downtrending liver enzymes underwent cholecystectomy without preoperative or intraoperative imaging. Thirty-eight patients (5.7%) had postoperative biliary imaging, of whom 22 (3.3%) had definite choledocholithiasis. One case of postoperative cholangitis occurred which required readmission and endoscopic retrograde cholangiopancreatography with no long-term morbidity. Presenting liver enzymes were significantly higher in the group found to have retained stones postoperatively than those without retained stones. Conclusions Patients presenting with biochemical evidence of choledocholithiasis who downtrend preoperatively can be safely managed by cholecystectomy with omission of biliary tract imaging.

AB - Background No consensus exists for the timing and utility of biliary imaging in patients with preoperative concern for choledocholithiasis. Methods Admissions to an acute care surgery service with evidence of choledocholithiasis undergoing same-admission cholecystectomy without preoperative or intraoperative imaging were identified. One-way analysis of variance on the log-transformed outcomes, with the Tukey-Kramer multiple comparison procedure, were used to compare means between groups. Results A total of 668 patients with elevated but downtrending liver enzymes underwent cholecystectomy without preoperative or intraoperative imaging. Thirty-eight patients (5.7%) had postoperative biliary imaging, of whom 22 (3.3%) had definite choledocholithiasis. One case of postoperative cholangitis occurred which required readmission and endoscopic retrograde cholangiopancreatography with no long-term morbidity. Presenting liver enzymes were significantly higher in the group found to have retained stones postoperatively than those without retained stones. Conclusions Patients presenting with biochemical evidence of choledocholithiasis who downtrend preoperatively can be safely managed by cholecystectomy with omission of biliary tract imaging.

KW - Choledocholithiasis

KW - ERCP

KW - Intraoperative cholangiogram

KW - Liver function tests

UR - http://www.scopus.com/inward/record.url?scp=84955668615&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84955668615&partnerID=8YFLogxK

U2 - 10.1016/j.amjsurg.2015.06.031

DO - 10.1016/j.amjsurg.2015.06.031

M3 - Article

C2 - 26506555

AN - SCOPUS:84955668615

VL - 210

SP - 1140

EP - 1146

JO - American Journal of Surgery

JF - American Journal of Surgery

SN - 0002-9610

IS - 6

ER -