|OB03 Biliary: Gallstones
|Selection of Presentations from Abstract Submissions
|OB03-02 ||Sphincter of Oddi Laxity Alters Bile Duct Microbiota and Contributes to the Recurrence of Chelodocholithiasis
Qi Zhang, China
Q. Zhang1, M. Ye1, X. Bai2, T. Liang2
1HBP Department, Zhejiang University, School of Medicine, the First Affiliated Hospital, China, 2Zhejiang University, School of Medicine, the First Affiliated Hospital, China
Background: Chelodocholithiasis is closely associated with bacterial infection and inflammation in the bile ducts. Our previous studies showed that sphincter of Oddi laxity (SOL) significantly altered the bile microbiota and might contribute to biliary stone recurrence. However, the direct association among SOL, bile microbiota, and chelodocholithiasis recurrence has not been well investigated.
Methods: We recruited 202 patients with chelodocholithiasis, and obtained the bile samples from the common bile duct. We performed 16S rRNA gene analysis to characterize the bile microbiota, and analyzed the risk factors of chelodocholithiasis.
Results: Distinct bile microbial communities were identified in patients with and without SOL with a significantly greater abundance of Rhizobiaceae in SOL patients. SOL patients had a higher risk of biliary stone recurrence with a considerably shorter recurrence time. The abundance of Clostridium was significantly higher in recurrent patients. SOL (P = 0.045, HR = 8.563) and pre-operative gamma-glutamyl transferase level (P = 0.037, HR = 1.002) were two independent risk factors of chelodocholithiasis recurrence.
Conclusions: Chelodocholithiasis patients with and without SOL demonstrated significant differences in their microbial communities. SOL is a critical risk factor of chelodocholithiasis recurrence after surgery. The presence of Clostridium is potentially associated with SOL-induced chelodocholithiasis recurrence.
|OB03-03 ||Natural History of Retained Common Bile Duct Calculi Noted on Intra-Operative Cholangiography
Andy Chen, Australia
A. Chen1, R. Tang2, P. Garg1, V. Lam1, T. Pang1
1Department of Surgery, Westmead Hospital, Australia, 2Department of Radiology, Westmead Hospital, Australia
Introduction: Incidental common bile duct (CBD) calculi is found in approximately 11% of
routine intra-operative cholangiograms (IOC) during laparoscopic
cholecystectomy (LC). An uncertain proportion of these may remain
asymptomatic or pass spontaneously, and therefore not require invasive
We aim to explore the natural history of retained CBD calculi in asymptomatic
patients to guide management for this common incidental operative finding.
Methods: Retrospective analysis of LC performed at an Australian tertiary hospital
from 2014 to 2018 was undertaken. Records of patients with filling defects
noted on IOC were reviewed. Incidental patients were defined by preoperative
bilirubin< 40µmol/L and gamma-glutamyl transferase< 500U/L. The main
endpoint was the passage of CBD calculus, determined by the absence of
choledocholithiasis on postoperative magnetic resonance
cholangiopancreatography (MRCP) or endoscopic retrograde cholangiopancreatography
Results: 1453(87%) patients underwent IOC with LC and filling defects were noted in
116(8%) of these. 75 incidental patients underwent postoperative
cholangiography within 30 days at a median of 3(IQR=2-6) days following LC. 32(43%)
patients had no residual choledocholithiasis. The median time to stone
passage was estimated at 10(95%CI 5.6-14.3) days. Retained
choledocholithiasis was detected in 72% of patients where no contrast passed
into the duodenum and 48% with duodenal contrast passage but filling defects
on IOC (p=0.049).
Conclusion: A significant proportion of incidental CBD calculi pass spontaneously within
14 days from LC. Expectant management with follow-up non-invasive imaging may
reduce unnecessary ERCP and minimise its associated complications. However,
failure of contrast passage into the duodenum on IOC may predict non-passage
|OB03-04 ||The Prevalence of Functional Gastrointestinal Disorders in Patients with Uncomplicated Cholecystolithiasis (PERFECT): a Prospective, Multicenter Observational Study
Carmen Sarah Sophie Latenstein, Netherlands
C.S.S. Latenstein1, J. de Jong2, D. Boerma3, E. Hazebroek4, J. Heikens5, J. Konsten6, F. Polat7, J. Drenth2, P. de Reuver1
1Surgery, Radboudumc, Netherlands, 2Gastroenterology and Hepatology, Radboudumc, Netherlands, 3Surgery, Antonius Ziekenhuis Nieuwegein, Netherlands, 4Surgery, Rijnstate, Netherlands, 5Surgery, Ziekenhuis Rivierenland, Netherlands, 6Surgery, Viecuri, Netherlands, 7Surgery, Canisius Wilhelmina Ziekenhuis, Netherlands
Background: Symptomatic gallstones, functional dyspepsia(FD),
and irritable bowel syndrome(IBS) have similar symptom pattern. This study
determined the prevalence of FD/IBS in patients with gallstones and assessed
the outcome of a cholecystectomy in terms of resolution of biliary colics and abdominal
Methods: A multicentre, prospective observational study
was conducted. Adult patients with abdominal pain and ultrasonically confirmed
gallstones were included. The presence of FD/IBS was assessed with the validated
ROME-IV questionnaire. A biliary colic was defined by the ROME-III criteria. Pain-free
was defined as an Izbicki Pain Score ≤10. Patients with and without FD/IBS at
baseline were compared.
Results: Between January 2018-April 2019, 401 patients (51.7 years, 76.3%
females) were included. In total, 34.9% (140/401) of the patients with
gallstones fulfilled the ROME-IV criteria for FD/IBS, and 64.1% (257/401) fulfilled
the ROME-III criteria for biliary colic. Cholecystectomy rate was similar
between the groups (73.8% in FD/IBS-group vs. 75.5% in patients without FD/IBS,
p=0.720). After follow-up of 24 weeks the biliary colic was resolved in 93.9%
of patients with surgery (91.4% in FD/IBS-group vs. 95.1% in patients without FD/IBS,
p=0.220). Pain-free after surgery was achieved in 56.8% of patients (40.7% in
FD/IBS-group vs. 64.4% in patients without FD/IBS, p< 0.001).
Conclusion: One-third of the patients with gallstones fulfil criteria for FD and/or IBS.
Cholecystectomy resolves biliary colics in 94% of patients, with similar
outcome between patients with and without FD/IBS. However, pain-free after
surgery is significantly less in patients with FD/IBS. This study partially explains
the poor pain reduction after cholecystectomy.
|OB03-05 ||Should Common Bile Duct Exploration Be a Specialist Only Procedure? a 10 Year Review of 551 Consecutive Patients
Russell Hodgson, Australia
R. Hodgson1,2, D. Heathcock1, C.-T. Kao1, R. Seagar1, M. Tacey1,2, T. Yong1, D. Bird1, N. Houli1,3
1Surgery, Northern Health, Australia, 2Surgery, University of Melbourne, Australia, 3Western Health, Australia
Introduction: Common bile duct (CBD) exploration is not
commonly performed, despite evidence that it may be superior to ERCP in the
treatment of choledocholithiasis. Issues surrounding its uptake in the
laparoscopic era include perceived difficulty and lack of training. We aim to
determine whether CBD exploration should be performed by 'specialist' CBD
Methods: A 10-year retrospective audit was performed of
patients undergoing CBD exploration for choledocholithiasis at Northern Health,
Australia. CBD exploration was performed almost exclusively using
choledochoscopy. Northern Health maintains an on-call available 'specialist'
CBD surgeon should the operating surgeon choose to utilise their service.
Results: 551 patients were identified, of which 489/551
(88.7%) patients had stones successfully cleared. 413 (75.0%) of operations
were done by a 'specialist'. Specialists had a higher success rate (90.8% vs
82.6%), possibly as they were more persistent with a longer surgical time (186
min vs 161 min). Method (transcystic or transductal), approach (laparoscopic or
open), pre-operative markers, and indication for operation were not different
between groups. In addition, there was no significant difference in
complication rates. When caseload was evaluated, to be confident of a surgeon
having a minimum 80% success rate, approximately 70 procedures over 10 years
Discussion: Specialist CBD exploration surgeons have
improved success rates compared with non-specialist general surgeons. However
non-specialist general surgeons also have a high success rate and, with similar
complication rates and to avoid a high learning curve requirement, they should
be encouraged to perform CBD exploration in centres without specialist CBD
|OB03-06 ||Long Term Outcomes of Trans-Cystic Bile Duct Exploration
Joel Lewin, Australia
C. O'Rourke, J. Lewin, P. Waters, L. Weber, D. Cavallucci, R. Bryant, N. O'Rourke
Royal Brisbane Hospital, Australia
transcystic common bile duct exploration (LTCBDE) at the time of
cholecystectomy for choledocholithasis negates the need for endoscopic
retrograde cholangiopancreatography (ERCP), along with its associated
complications and cost. The aim of this study was to assess the long-term outcomes
associated with TCBDE.
Methods: Patients undergoing LTCBDE at the Royal
Brisbane Hospital between 1995 and 2019 were retrospectively analysed. LTCBDE
was performed using a 5.5-Fr wire basket kit (Cook Australia) under
fluoroscopic guidance. Satisfactory completion of the CBD exploration was
confirmed by completion cholangiography. Patients had clinical follow up post
discharge. Data were analysed using R statistics with a p< 0.05 considered significant.
Results: 397 patients underwent LTCBDE,
with 262 females. The median age was 52 years old (range 16-88). Median follow
up was 5.4 years, and the median length of hospital stay was 1 day (range 0 -
28). 28 patients (7.1%) required
postoperative ERCP for failure of complete stone clearance at LTCBDE. Two patients
developed mild acute pancreatitis postoperatively after successful duct
clearance. Four patients (1%) required ERCP following discharge post LTCBDE,
after representing with symptomatic choledocholithiasis. Overall, 91.9% of
patients had successful bile duct clearance with LTCBDE. Cost analysis comparing
LTCBDE with the average cost of patients undergoing ERCP followed by
laparoscopic cholecystectomy showed LTCBDE to be significantly less
Conclusion: Upfront laparoscopic CBDE
is now a well-established practice at this unit. This study reports a high rate
of bile duct stone clearance with LTCBDE, with minimal complications and obvious
|OB03-07 ||The Outcomes of Laparoscopic Common Bile Duct Exploration and Cholecystectomy: Results from a Prospective Multi-centre Cohort Study (The Choles Study)
Andrei Tanase, United Kingdom
S. Aroori, A. Tanase, Chole S
Peninsula HPB Unit, Plymouth, University Hospitals Plymouth NHS Trust, United Kingdom
Background: The aim of this study is to analyse the results of laparoscopic common bile duct exploration (LCBDE) and cholecystectomy (LC) performed across the UK and Ireland during Chole S trial period.
Methods: We analysed the data on LCBDEs that were performed during the two-month CholeS Study trial period.
Results: During the trial period, 256 patients (2.9%, 173 females, Median age: 59 years) out of 8820 LC underwent LCBDEs. During the same time period, 932 (10.6%) patients underwent endoscopic retrograde cholangio-pancreatography (ERCP) +and sphincterotomy (ES). Eighty percent of patients were either overweight or obese. 73 (28.5%) patients had ERCP and 112 (43.8%) patients had Magnetic resonance cholangio-pancreatography (MRCP), prior to LCBDE. The overall conversion rate was 13%. Two-thirds of patients had intra-operative cholangiogram prior to LCBDE. Median length of operation was 111 min (range: 75-155). Median length of hospital stay was 6 days (range: 4-11) for LCBDEs performed acutely (90/256, 35%) compared to 1 day (range: 1-4) for elective cases. The post-operative complication rate was 22.7%, and the bile leak rate was 5.3%. The all cause 30-day re-admission rate was 11.9% and 30-day mortality was 0.4%.
Conclusions: LCBDE is still not commonly used treatment option for CBDS across the UK and Ireland. Nearly half of patients had pre-op MRCP and one fourth of patients had ERCP prior to surgery. Patients that had LCBDE in an acute situation had longer hospital stay compared to elective patients. Further studies are required to find out the reasons for low utilisation of LCBDE.