Common bile duct stones and cholecystectomy: A prospective multicentric study comparing different treatments

R. Conigliaro, E. Ricci, R. Sassatelli, D. Pacchione, G. Bertoni, M. G. Mortilla, S. Bronzoni, G. Bedogni

Research output: Contribution to journalArticle

Abstract

One hundred and fourty two patients with symptomatic cholelithiasis and demonstrated (by ultrasound scanning or i.v. cholangiography) or suspected common bile duct stones were non-randomly enrolled (from July 1992 to December 1993) following a common protocol agreed to in advance by the 'Combined therapy study group' (i.e. an Italian multicentric group). Urgent patients were excluded. Patients were subdivided into four Groups: Group 1 (69 patients) treated with Endoscopic Sphincterotomy (ES) and Laparoscopic Cholecystectomy (LC), Group 2 (20 patients) had ES prior to Laparotomic Cholecystectomy (LTC), Group 3 (49 patients) who underwent laparotomic common bile duct exploration (Surgery alone), cholecystectomy and T-tube drainage in the common bile duct. Finally Group 4 (4 patients) where the patients had laparoscopic exploration of the CBD and transcystic stone removal. The efficacy of therapy, complications and mean hospital stay were considered and analyzed statistically. Results obtained showed that the complication rate was not significantly different between Group 1 (10%) and Group 2 (20%) and between Group 2 and Group 3 (6.1%). The average hospital stay was significantly different between Group 1 and 3:7.2 ± 0.9 vs 14.4 ± 3.2 (P <0.001). Groups 1,2 and 3 were comparable even if the patients were older in Groups 2 and 3 (mean age 66.4 ± 3.3 and 66.02 ± 2.2 vs 57.9 ± 1.8 of Group 1: P = 0.005) because young people generally refused conventional treatment with open surgery, and Group 3 patients had worse and significantly different ASA grade then Group 1 (2 = 11.5 -2df; P = 0.003). Stones number was not significantly different in the four groups considered. Conversely, stone diameter was larger in group 2 and 3 (P = 0.018 and P = 0.022) and CBD diameter was smaller in the group treated preoperatively with LS and stone removal (P = 0.018). It was impossible to compare Group 4 (Laparoscopic management alone) with others because the groups are too unbalanced. Conclusions: the combined method (ES + LC or + LTC) is as safe and effective as open surgery; the hospital stay and the costs are lower with this method; in laparoscopic era it is still the preferred treatment in preoperative suspicion of CBD stones. Laparoscopic common bile duct exploration is still a desirable option but to date it is only an unroutinary method to treat the CBD stones. The aim of this therapy rests to find a management that is safe, quick and effective in one session. Consequently we feel that intraoperative ES during LC might be an interesting approach for the treatment of CBD stone.

Original languageEnglish
Pages (from-to)237-245
Number of pages9
JournalGiornale Italiano di Endoscopia Digestiva
Volume18
Issue number4
Publication statusPublished - 1995

Keywords

  • choledocholithiasis
  • cholelithiasis
  • endoscopic sphincterotomy
  • laparoscopic cholecistectomy
  • laparoscopic stone extraction
  • open surgery

ASJC Scopus subject areas

  • Gastroenterology

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