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AuthorScheuritzel, Uwedc.contributor.author
Date of accession2016-03-14T13:40:58Zdc.date.accessioned
Available in OPARU since2016-03-14T13:40:58Zdc.date.available
Year of creation2006dc.date.created
AbstractBackground: A concept of "selective diagnostics" in laparoscopic cholecystectomy (LC) for gallstones was evaluated: Only on patients with suspected common bile duct (CBD) stones a preoperative endoscopic retrograde cholangiopancreatography (ERCP) is performed followed by LC the next day ("therapeutic splitting"). The aim of this retrospective study was to determine the prevalence of choledocholithiasis and to validate a scoring system for the prediction of choledocholithiasis based on alkaline phosphatase, bilirubin, gamma-glutamyltransferase, common bile duct dilatation on preoperative ultrasound, and a history of jaundice. If >= 2 criteria are positive, a preoperative ERCP should be performed before LC. Methods: A total of N = 1,197 consecutive patients were approached and N = 876 (73.1 %) completed questionnaires were returned. Statistical analyses included chi-square tests and stepwise multiple logistic regression analysis. Results: The prevalence of choledocholithiasis was 3.4 %. In 0.9 % choledocholithiasis was missed peroperatively. The overall sensitivity of the scoring system was 57.1 %, while specificity was 88.7 %. Positive predictive value (ppv) was 15.2 %, while negative predictive value (npv) was 98.3 %. Multiple logistic regression analysis identified alkaline phosphatase (p < 0.01) and common bile duct dilatation at preoperative ultrasound (p < 0.001) as independent predictive factors of common bile duct stones. Conclusion: With a prevalence of 3.4 % of CBD stones in patients undergoing laparoscopic cholecystectomy for symptomatic gallstones and a rate of 0.9 % patients with postoperative choledocholithiasis the concept of selective diagnostics of the bile duct appears to be efficient. Although it is difficult to define predictive factors of choledocholithiasis, the above combination of indicators of duct stones in a scoring system to predict choledocholithiasis preoperatively is a simple and safe method using results of routine preoperative investigations.dc.description.abstract
Languagededc.language.iso
PublisherUniversität Ulmdc.publisher
LicenseStandard (Fassung vom 03.05.2003)dc.rights
Link to license texthttps://oparu.uni-ulm.de/xmlui/license_v1dc.rights.uri
KeywordPrediction of choledocholithiasisdc.subject
KeywordScoring systemdc.subject
KeywordStepwise multiple logistic regression analysisdc.subject
KeywordTherapeutic splittingdc.subject
Dewey Decimal GroupDDC 610 / Medicine & healthdc.subject.ddc
MeSHCholecystectomy, laparoscopicdc.subject.mesh
MeSHGallstonesdc.subject.mesh
TitleValidierung eines Diagnoseschemas zur präoperativen Detektion von Gallengangskonkrementen bei der laparoskopischen Cholezystektomiedc.title
Resource typeDissertationdc.type
DOIhttp://dx.doi.org/10.18725/OPARU-749dc.identifier.doi
URNhttp://nbn-resolving.de/urn:nbn:de:bsz:289-vts-57875dc.identifier.urn
GNDCholezystektomiedc.subject.gnd
GNDGallengangdc.subject.gnd
FacultyMedizinische Fakultätuulm.affiliationGeneral
Date of activation2006-12-18T09:19:03Zuulm.freischaltungVTS
Peer reviewneinuulm.peerReview
Shelfmark print versionZ: J-H 11.357 ; W: W-H 9.467uulm.shelfmark
DCMI TypeTextuulm.typeDCMI
VTS ID5787uulm.vtsID
CategoryPublikationenuulm.category
Bibliographyuulmuulm.bibliographie


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