| Title |
Surgeons, ERCP, and laparoscopic common bile duct exploration: do we need a standard approach for common bile duct stones?
|
|---|---|
| Published in |
Surgical Endoscopy, June 2015
|
| DOI | 10.1007/s00464-015-4273-z |
| Pubmed ID | |
| Authors |
Rebeccah B. Baucom, Irene D. Feurer, Julia S. Shelton, Kristy Kummerow, Michael D. Holzman, Benjamin K. Poulose |
| Abstract |
Variation exists in the management of choledocholithiasis (CDL). This study evaluated associations between demographic and practice-related characteristics and CDL management. A 22-item, web-based survey was administered to US general surgeons. Respondents were classified into metropolitan or nonmetropolitan groups by zip code. Univariate tests and multivariable logistic regression were used to determine factors associated with CDL management preferences. The survey was sent to 32,932 surgeons; 9902 performed laparoscopic cholecystectomy within the last year; 750 of 771 respondents had a valid US zip code and were included in the analysis. Mean practice time was 18 ± 10 years, 87 % were male, and 83 % practiced in a metropolitan area. For preoperatively known CDL, 86 % chose preoperative endoscopic retrograde cholangiopancreatography (ERCP). Those in metropolitan areas were more likely to select preoperative ERCP than those in nonmetropolitan areas (88 vs. 79 %, p < 0.001). For CDL discovered intraoperatively, 30 % selected laparoscopic common bile duct exploration (LCBDE) as their preferred method of management with no difference between metropolitan and nonmetropolitan areas (30 vs. 26 %, p = 0.335). The top reasons for not performing LCBDE were: having a reliable ERCP proceduralist available, lack of equipment, and lack of comfort performing LCBDE. Factors associated with preoperative ERCP were: metropolitan status, selective intraoperative cholangiography (IOC), and availability of a reliable ERCP proceduralist. Those who perform selective IOC were 70 % less likely to prefer LCBDE (OR 0.32, 95 % CI 0.18-0.57, p < 0.001). Those with a reliable ERCP proceduralist available were 90 % less likely to prefer LCBDE (OR 0.10, 95 % CI 0.04-0.26, p < 0.001). The majority of respondents preferred ERCP for the management of CDL. Having a reliable ERCP proceduralist available, use of selective IOC, and metropolitan status were independently associated with preoperative ERCP. Postoperative ERCP was preferred for managing intraoperatively discovered CDL. Many surgeons are uncomfortable performing LCBDE, and increased training may be needed. |
Mendeley readers
The data shown below were compiled from readership statistics for 63 Mendeley readers of this research output. Click here to see the associated Mendeley record.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Unknown | 63 | 100% |
Demographic breakdown
| Readers by professional status | Count | As % |
|---|---|---|
| Researcher | 11 | 17% |
| Other | 9 | 14% |
| Student > Postgraduate | 6 | 10% |
| Student > Master | 5 | 8% |
| Librarian | 4 | 6% |
| Other | 17 | 27% |
| Unknown | 11 | 17% |
| Readers by discipline | Count | As % |
|---|---|---|
| Medicine and Dentistry | 37 | 59% |
| Biochemistry, Genetics and Molecular Biology | 3 | 5% |
| Agricultural and Biological Sciences | 1 | 2% |
| Nursing and Health Professions | 1 | 2% |
| Computer Science | 1 | 2% |
| Other | 1 | 2% |
| Unknown | 19 | 30% |
Attention Score in Context
This research output has an Altmetric Attention Score of 1. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 02 February 2016.
All research outputs
#20,303,950
of 22,842,950 outputs
Outputs from Surgical Endoscopy
#5,650
of 6,040 outputs
Outputs of similar age
#220,204
of 264,385 outputs
Outputs of similar age from Surgical Endoscopy
#108
of 124 outputs
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We're also able to compare this research output to 124 others from the same source and published within six weeks on either side of this one. This one is in the 1st percentile – i.e., 1% of its contemporaries scored the same or lower than it.