Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery最新文献

{"title":"RATIO OF METASTATIC LYMPH NODES VS. RESECTED LYMPH NODES (N-RATIO) HAS PROGNOSTIC IMPLICATIONS IN GASTRIC CANCER.","authors":"Breno Cordeiro Porto, Marina Alessandra Pereira, Marcus Fernando Kodama Pertille Ramos, André Roncon Dias, Fábio Pinatel Lopasso, Luiz Augusto Carneiro D'Albuquerque, Ulysses Ribeiro Junior","doi":"10.1590/0102-6720202400031e1824","DOIUrl":"https://doi.org/10.1590/0102-6720202400031e1824","url":null,"abstract":"<p><strong>Background: </strong>Lymph node status is vital for gastric cancer (GC) prognosis, but the conventional pN stage may be limited by variations in lymphadenectomy and stage migration. The N-Ratio, which assesses the ratio of metastatic to resected lymph nodes, emerges as a promising prognostic tool.</p><p><strong>Aims: </strong>To assess N-Ratios prognostic value in GC, particularly in patients with <25 resected lymph nodes.</p><p><strong>Methods: </strong>Patients who underwent gastrectomy with curative intent for GC were retrospectively evaluated. The N-Ratio categories were determined using the ROC curve method, and the area under the curve (AUC) was used as a measure of performance in predicting recurrence/death.</p><p><strong>Results: </strong>A total of 561 GC patients were included in the study, 57% had pN+ status, and 17.5% had <25 resected lymph nodes. N-Ratio, with a mean of 0.12, predicted survival with 74% accuracy (AUC=0.74; 95%CI 0.70-0.78, p<0.001). N-Ratio categories included: N-Ratio 0 (43%); N-Ratio 1 (12.3%); N-Ratio 2 (31.6%); and N-Ratio 3 (13.2%). Disease-free survival (DFS) varied among all N-Ratio groups, with N-Ratio 3 showing worse survival than pN3 cases (DFS=21.8 vs. 11 months, p=0.022, p<0.05). In cases with <25 resected lymph nodes, DFS was not significantly worse in N-Ratio 0 (68.8 vs. 81.9%, p=0.061, p>0.05) and N-Ratio 1 (66.2 vs. 50%, p=0.504, p>0.05) groups. The DFS of N-Ratio-0 cases with <25 lymph nodes was similar to N-Ratio 1 cases.</p><p><strong>Conclusions: </strong>N-Ratio influenced survival in GC patients, especially in advanced lymph node disease (N-Ratio 3). Considering that N-Ratio does not impact pN0 cases, individualized prognosis assessment is essential for patients with <25 resected lymph nodes.</p>","PeriodicalId":72298,"journal":{"name":"Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery","volume":"37 ","pages":"e1824"},"PeriodicalIF":0.0,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11419286/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142333623","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"EARLY OUTCOMES OF ROBOTIC ENHANCED VIEW TOTALLY EXTRAPERITONEAL VENTRAL HERNIA REPAIR: A SINGLE-CENTER EXPERIENCE.","authors":"Rodrigo Piltcher-DA-Silva, Pedro San Martin Soares, Beatriz Carolina Schuta Bodanese, Gabriel Jasinski, Ana Carolina de Oliveira Makiyama, João Rafael Bora Ruggeri, Júlio Cezar Uili Coelho, Christiano Marlo Paggi Claus","doi":"10.1590/0102-6720202400032e1825","DOIUrl":"https://doi.org/10.1590/0102-6720202400032e1825","url":null,"abstract":"<p><strong>Background: </strong>Incisional hernia (IH) is an abdominal wall defect due to a previous laparotomy, and surgical repair is the only treatment. IH has a negative impact on patients' quality of life. In the last decades, the approach has improved from open to laparoscopic and robotic surgery with the objective of promoting better abdominal wall function after reconstruction. Today, robotic enhanced-view totally extraperitoneal (reTEP) is one of the most advanced techniques for abdominal wall reconstruction.</p><p><strong>Aims: </strong>The aim of this study was to analyze the early results of patients with incisional hernia submitted to repair with reTEP.</p><p><strong>Methods: </strong>This is a retrospective cohort study, and all patients who underwent reTEP surgery for ventral hernia in the years 2021 and 2022 were included. The only exclusion criteria were patients who underwent another type of herniorrhaphy. Statistical analysis was performed using the Stata software.</p><p><strong>Results: </strong>A total of 32 participants were submitted to reTEP; the majority had an incisional hernia, and according to the European Hernia Society, EUS-M score 3 was the most prevalent. The mean surgical time was 170 min, and the console time was 142 min. Most patients stayed 2 days in the hospital. No intraoperative complications were reported.</p><p><strong>Conclusions: </strong>reTEP is a safe and effective technique and has favorable outcomes in the early postoperative period. Further studies with larger sample sizes and longer follow-up periods are needed to confirm these findings.</p>","PeriodicalId":72298,"journal":{"name":"Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery","volume":"37 ","pages":"e1825"},"PeriodicalIF":0.0,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11407091/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142302296","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"IS THERE A ROLE FOR BILIODIGESTIVE BYPASS SURGERY IN TREATING CHOLESTASIS IN ADVANCED PANCREATIC CANCER?","authors":"Lucas Cata Preta Stolzemburg, Francisco Tustumi, Thiago Costa Ribeiro, Ricardo Jureidini, Mauricio Paulin Sorbello, Fauze Maluf-Filho, José Jukemura, Ulysses Ribeiro Junior, Guilherme Naccache Namur","doi":"10.1590/0102-6720202400030e1823","DOIUrl":"https://doi.org/10.1590/0102-6720202400030e1823","url":null,"abstract":"<p><strong>Background: </strong>The unresectable pancreatic head tumors develop obstructive jaundice and cholestasis during follow-up. Cholestasis is associated with complications and treatment options are endoscopic stenting (ES) and biliary bypass surgery (BBS).</p><p><strong>Aims: </strong>The aim of the current study was to compare the safety and efficacy of biliary bypass surgery (BBS) and endoscopic stenting (ES) for cholestasis in advanced pancreas cancer.</p><p><strong>Methods: </strong>This is a retrospective cohort of patients with cholestasis and unresectable or metastatic pancreas cancer, treated with BBS or ES. Short and long-term outcomes were evaluated. We considered the need for hospital readmission due to biliary complications as treatment failure.</p><p><strong>Results: </strong>A total of 93 patients (BBS=43; ES=50) were included in the study. BBS was associated with a higher demand for postoperative intensive care (37 vs.10%; p=0.002, p<0.050), longer intensive care unit stay (1.44 standard deviation±2.47 vs. 0.66±2.24 days; p=0.004, p<0.050), and longer length of hospital stay (7.95±2.99 vs. 4.29±5.50 days; p<0.001, p<0.050). BBS had a higher risk for procedure-related complications (23 vs. 8%; p=0.049, p<0.050). There was no difference in overall survival between BBS and ES (p=0.089, p>0.050). ES was independently associated with a higher risk for treatment failure than BBS on multivariate analysis (hazard ratio 3.97; p=0.009, p<0.050).</p><p><strong>Conclusions: </strong>BBS is associated with longer efficacy than ES for treating cholestasis in advanced pancreatic cancer. However, the BBS is associated with prolonged intensive care unit and hospital stays and higher demand for intensive care.</p>","PeriodicalId":72298,"journal":{"name":"Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery","volume":"37 ","pages":"e1823"},"PeriodicalIF":0.0,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11407092/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142302308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"METABOLIC DYSFUNCTION-ASSOCIATED STEATOTIC LIVER DISEASE - ASSESSMENT OF PATIENTS WITH OBESITY AND METABOLIC SYNDROME - GUIDELINE FROM THE BRAZILIAN SOCIETY OF BARIATRIC AND METABOLIC SURGERY.","authors":"Leonardo Halamy Pereira, Fernando de Barros, Thais Guaraná de Andrade, Alvaro Albano de Oliveira Neto, Cristiane Alves Villela Nogueira, Antonio Carlos Valezi","doi":"10.1590/0102-6720202400028e1821","DOIUrl":"10.1590/0102-6720202400028e1821","url":null,"abstract":"<p><strong>Background: </strong>Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most prevalent chronic liver disease in the world and was recently renamed to emphasize its metabolic component.</p><p><strong>Aims: </strong>This article seeks to fill the gap in specific guidelines for patients with obesity and MASLD who will undergo bariatric surgery.</p><p><strong>Methods: </strong>A systematic search for guidelines was carried out on PubMed and Embase platforms.</p><p><strong>Results: </strong>A total of 544 articles were found, of which 11 were selected according to inclusion and exclusion criteria. All 11 guidelines are from clinical societies; therefore, they do not include some necessary interpretations for bariatric patients.</p><p><strong>Conclusions: </strong>We recommend that every patient undergoing bariatric and metabolic surgery be screened initially with the Fibrosis-4 (FIB-4) score, followed by transient hepatic elastography (vibration-controlled transient elastography, VCTE), especially for those with FIB-4>1.3. However, interpreting VCTE results in obese patients requires further studies to define the actual cutoff values. Enhanced Liver Fibrosis® shows promise but its availability is limited. The indication for liver biopsy during surgery needs to be individualized but it is recommended for those with changes in FIB-4 and/or VCTE. Family screening is recommended for relatives of young patients with already advanced fibrosis. Liver transplantation is an option for patients with advanced MASLD but the optimal timing for bariatric surgery with transplantation is still unclear. Regular follow-up and VCTE examination are recommended to monitor disease progression after surgery.</p>","PeriodicalId":72298,"journal":{"name":"Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery","volume":"37 ","pages":"e1821"},"PeriodicalIF":0.0,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11368249/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142127509","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ROBOTIC PANCREATODUODENECTOMY IN BRAZIL: LESSONS AFTER 15 YEARS OF THE FIRST CASE.","authors":"Marcos Belotto, Orlando Jorge Martins Torres","doi":"10.1590/0102-6720202400029e1822","DOIUrl":"10.1590/0102-6720202400029e1822","url":null,"abstract":"","PeriodicalId":72298,"journal":{"name":"Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery","volume":"37 ","pages":"e1822"},"PeriodicalIF":1.8,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11368248/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142127523","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"EFFICACY AND SAFETY OF ONE ANASTOMOSIS GASTRIC BYPASS IN SURGICAL TREATMENT OF OBESITY: SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS.","authors":"Tiago Rafael Onzi, Wilson Salgado Júnior, Eduardo Lemos de Souza Bastos, Anna Carolina Batista Dantas, Lyz Bezerra Silva, Alvaro Albano de Oliveira Neto, Luca Schiliró Tristão, Clara Lucato Dos Santos, Wanderley Marques Bernardo, Matheus Pedrotti Chavez","doi":"10.1590/0102-6720202400021e1814","DOIUrl":"10.1590/0102-6720202400021e1814","url":null,"abstract":"<p><strong>Background: </strong>One anastomosis gastric bypass (OAGB) has gained prominence in the search for better results in bariatric surgery. However, its efficacy and safety compared to Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) remain ill-defined.</p><p><strong>Aims: </strong>To compare the efficacy and safety of OAGB relative to RYGB and SG in the treatment of obesity.</p><p><strong>Methods: </strong>We systematically searched PubMed, EMBASE, Cochrane Library, Lilacs, and Google Scholar databases for randomized controlled trials comparing OAGB with RYGB or SG in the surgical approach to obesity. We pooled outcomes for body mass index, percentage of excess weight loss, type-2 diabetes mellitus remission, complications, and gastroesophageal reflux disease. Statistical analyses were performed with R software (version 4.2.3).</p><p><strong>Results: </strong>Data on 854 patients were extracted from 11 randomized controlled trials, of which 422 (49.4%) were submitted to OAGB with mean follow-up ranging from six months to five years. The meta-analysis revealed a significantly higher percentage of excess weight loss at 1-year follow-up and a significantly lower body mass index at 5-year follow-up in OAGB patients. Conversely, rates of type-2 diabetes mellitus remission, complications, and gastroesophageal reflux disease were not significantly different between groups. The overall quality of evidence was considered very low.</p><p><strong>Conclusions: </strong>Our results corroborate the comparable efficacy of OAGB in relation to RYGB and SG in the treatment of obesity, maintaining no significant differences in type-2 diabetes mellitus remission, complications, and gastroesophageal reflux disease rates.</p>","PeriodicalId":72298,"journal":{"name":"Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery","volume":"37 ","pages":"e1814"},"PeriodicalIF":0.0,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11363908/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142127507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"LAPAROTOMIC RADIOFREQUENCY ABLATION OF PANCREATIC INSULINOMA.","authors":"Allan Rubens Zucolotto Cansi, Jhonatan de Souza Vitor, João Felipe da Silva Lopes, Rogério Dardengo Glória","doi":"10.1590/0102-6720202400026e1819","DOIUrl":"10.1590/0102-6720202400026e1819","url":null,"abstract":"<p><p>Insulinomas are rare neoplasms of the endocrine pancreas. Minimally invasive treatment options for insulinomas have gained prominence, replacing surgical resection due to its associated morbidity and mortality. Radiofrequency ablation (RFA) has emerged as a relevant treatment option. We present a case of a female patient with neuroglycopenic symptoms and severe hypoglycemic crises. The abdominal magnetic resonance imaging (MRI) showed a small nodular lesion in the pancreatic body. Laparotomy was performed, followed by RFA using a 15-mm active-tipped needle. No complications transpired, and no hypoglycemic episodes were observed during 12 months of follow-up.</p>","PeriodicalId":72298,"journal":{"name":"Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery","volume":"37 ","pages":"e1819"},"PeriodicalIF":0.0,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11363906/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142127508","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"RESULTS OF MECHANIC VERSUS MOTORIZED STAPLER USED IN GASTRIC SURGERY: PROSPECTIVE STUDY.","authors":"Italo Braghetto, Gustavo Czwiklitzer, Owen Korn, Percy Brante, Ana Burgos","doi":"10.1590/0102-6720202400025e1818","DOIUrl":"10.1590/0102-6720202400025e1818","url":null,"abstract":"<p><strong>Background: </strong>Mechanic sutures represent an enormous benefit for digestive surgery in decreasing postoperative complications. Currently, the advantages of motorized stapler are under evaluation.</p><p><strong>Aims: </strong>To compare the efficacy of mechanic versus motorized stapler in gastric surgery, analyzing rate of leaks, bleeding, time of stapling, and postoperative complications.</p><p><strong>Methods: </strong>Ninety-eight patients were submitted to gastric surgery, divided into three groups: laparoscopic sleeve gastrectomy (LSG) (n=47), Roux-en-Y gastric bypass (LRYGB) (n=30), and laparoscopic distal gastrectomy (LDG) (n=21). Motorized staplers were employed in 61 patients. The number of firings, number of clips, time of total firings, total time to complete the surgery, and postoperative outcome were recorded in a specific protocol.</p><p><strong>Results: </strong>Patients submitted to LSG, LRYGB, and LDG recorded a shorter time to complete the procedure and a smaller number of firings were observed using motorized stapler (p<0.0001). No differences were identified regarding the number of clips used in patients submitted to LSG. In the group that used mechanic stapler to complete gastrojejunostomy, jejuno-jejuno-anastomosis, and jejunal transection, it was observed more prolonged time of firing and total time for finishing the procedure (p=0.0001). No intraoperative complications were found comparing the two devices used. Very similar findings were noted in the group of patients undergoing LDG.</p><p><strong>Conclusions: </strong>The motorized stapler offers safety and efficacy as demonstrated in prior reports and is relevant since less total time of surgical procedure without intraoperative or postoperative complications were confirmed.</p>","PeriodicalId":72298,"journal":{"name":"Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery","volume":"37 ","pages":"e1818"},"PeriodicalIF":0.0,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11363907/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142127522","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"SURGICAL SITE INFECTION IN RESECTIONS OF DIGESTIVE SYSTEM TUMOURS.","authors":"Adriano Carneiro da Costa, Fernando Santa-Cruz, Ana Valéria Torres, Eduarda Augusta de Lucena Caldas, Alessandro Mazzota, Flávio Kreimer, Álvaro Antônio Bandeira Ferraz","doi":"10.1590/0102-6720202400024e1817","DOIUrl":"10.1590/0102-6720202400024e1817","url":null,"abstract":"<p><p>Postoperative infectious complications are extremely important to surgeons and the entire medical care team. Among these complications, surgical site infection (SSI) appears to be one of the earliest and most prevalent events and is considered an inherent complication of surgical procedures. In oncological patients submitted to resections of digestive system tumors, there is a confluence of several risk factors for SSI, making it necessary to establish measures to maximize the control of this condition to provide a better prognosis for these patients. Some risk factors for SSI are the manipulation of structures hosting the highest density of pathogenic microorganisms, such as the colon, the patient's performance status, the patient's nutritional status, the use of chemotherapy and/or radiotherapy, and the surgical procedure itself, which tends to last longer and be more complex than surgeries for benign conditions of the digestive system. Therefore, this review sought to provide a qualitative analysis and a summary of the literature regarding the SSI of postoperative tumor patients who underwent surgical resection and were well-structured postoperatively, to provide objective data on this problem, and alert about the well-structured needs of individualized pre-, peri-, and post-protocols to avoid the development of these events.</p>","PeriodicalId":72298,"journal":{"name":"Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery","volume":"37 ","pages":"e1817"},"PeriodicalIF":0.0,"publicationDate":"2024-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11338518/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142019799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CHOLECYSTECTOMY WITH INTRAOPERATIVE ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY: DOES THE ORDER MATTER?","authors":"João de Bona Castelan Filho, Arthur Pizzolatti Zapelini, Felipe Antônio Cacciatori, Bruno Zilberstein","doi":"10.1590/0102-6720202400023e1816","DOIUrl":"10.1590/0102-6720202400023e1816","url":null,"abstract":"<p><strong>Background: </strong>The recommended treatment for cholecystocholedocholithiasis is cholecystectomy (CCT) associated with endoscopic retrograde cholangiopancreatography (ERCP). CCT with intraoperative ERCP is associated with higher success rates and lower hospital stays and hospital costs. However, some case series do not describe the exact methodology used: whether ERCP or CCT was performed first.</p><p><strong>Aims: </strong>Verify if there is a difference, in terms of outcomes and complications, when intraoperative ERCP is performed immediately before or after CCT.</p><p><strong>Methods: </strong>This is a retrospective case-control study analyzing all patients who underwent CCT with intraoperative ERCP between January 2021 and June 2022, in a tertiary hospital in southern Brazil, for the treatment of cholecystocholedocholithiasis.</p><p><strong>Results: </strong>Out of 37 patients analyzed, 16 (43.2%) underwent ERCP first, immediately followed by CCT. The overall success rate for the cannulation of the bile duct was 91.9%, and bile duct clearance was achieved in 75.7% of cases. The post-ERCP pancreatitis rate was 10.8%. When comparing the \"ERCP First\" and \"CCT First\" groups, there was no difference in technical difficulty for performing CCT. The \"CCT First\" group had a higher rate of success in bile duct cannulation (p=0.020, p<0.05). Younger ages, presence of stones in the distal common bile duct and shorter duration of the procedure were factors statistically associated with the success of the bile duct clearance. Lymphopenia and cholecystitis as an initial presentation, in turn, were associated with failure to clear the bile duct.</p><p><strong>Conclusions: </strong>There was no significant difference in terms of complications and success in clearing the bile ducts among patients undergoing CCT and ERCP in the same surgical/anesthetic procedure, regardless of which procedure was performed first. Lymphopenia and cholecystitis have been associated with failure to clear the bile duct.</p>","PeriodicalId":72298,"journal":{"name":"Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery","volume":"37 ","pages":"e1816"},"PeriodicalIF":0.0,"publicationDate":"2024-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11338519/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142019798","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}