[Surgical treatment of common bile duct calculi. Results and outcome in a series of 707 cases].
From 1965 to 1990, 707 patients (22 p. cent aged between 70 and 80 and 6% over 80) were operated on for common bile duct (CBD) stones, with intraoperative cholangiography and endoscopic control of the duct patency since 1977. Before 1981, all patients were operated on (n = 546). After 1981, 161 patients were operated on, 30 had an endoscopic sphincterotomy (ES) and the operation was completed by an ES in 9 patients for retained stones voluntarly (n = 5) or unvoluntarly (n = 4). Before 1981, there were no postoperative deaths. One patient died during the anesthetic induction and was not operated on. After 1981, there were 3 deaths: no death after surgery, 1 after surgery + ES from acute cholangitis with multiple hepatic abscesses and 2 after ES in high risk patients. After 1981, there were no biliopancreatic postoperative complications. The incidence of operations for CBD stones has decreased in our series (400 between 1970 and 1979, 190 between 1980 and 1989) and the proportion between operations for CBD stones and operations for gallstones has decreased from 14% before 1981 to 8% after 1981. The declining of surgery is in relation to the increasing of ES. Many factors may influence the choice between surgery and ES: 1--age and general health problems, 2--complicated (jaundice, acute cholangitis, acute pancreatitis) or non complicated lithiasis, 3--gallbladder in situ with or without stones, or anterior cholecystectomy, 4--predictive difficulties for ES or for extraction of stones through ES, 5--predictive difficulties for surgery or extraction of stones through hepaticotomy, 6--experience of the endoscopic and surgical teams.(ABSTRACT TRUNCATED AT 250 WORDS)
Moreaux
J
J
C.M.C. de la Porte de Choisy, Paris.
D000368:Aged; D000369:Aged, 80 and over; D002763:Cholecystectomy; D004322:Drainage; D005260:Female; D005500:Follow-Up Studies; D042882:Gallstones / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D013105:Sphincterotomy, Transduodenal
Traitement chirurgical de la lithiase de la voie biliaire principale. Ses résultats et son évolution dans une série de 707 cas.