[Is simultaneous cholecystectomy and choledochal exploration obsolete?].
Perioperative data on 284 patients who had simultaneously undergone cholecystectomy and surgical exploration of the bile duct were analysed. The procedures had been performed electively in 234 patients (145 females, 89 males; median age 61.5 [20-84] years). Freedom from stone was achieved in 96.2%; complication rate was 25.2% and death rate 2.6%. There was no death among patients without any or only one risk factor, while the morbidity rate for them was 18%. There were five deaths among 34 patients with four or more risk factors, and 13 (38.2%) had complications. Three of the patients who had died had been operated on because of septic, obstructive cholangitis with fever greater than 37.5 degrees C and bilirubin levels greater than 5 mg/dl. The operation was performed as an emergency in 50 patients (32 females, 18 males; median age 71.5 [24-93] years. 94% of them were free of stone afterwards; death rate was 10%, complication rate 44%. These data suggest that indications for the double surgical procedure in case of cholecysto-choledocholithiasis should be related to risk factors. In an emergency and in patients at risk, endoscopic papillotomy and stone extraction should precede cholecystectomy. But the one-time and thus definitive double surgical procedure remains the management of choice for patients with few or no risk factors.
Förster
R
R
Klinik für Allgemeinchirurgie, Universität Marburg.
Lindlar
R
R
Vorbeck
B
B
Rothmund
M
M
D000367:Age Factors; D002763:Cholecystectomy / Q000379:methods / Q000401:mortality / Q000706:statistics & numerical data*; D003135:Common Bile Duct / Q000601:surgery*; D042882:Gallstones / Q000150:complications / Q000453:epidemiology / Q000401:mortality / Q000601:surgery; D005860:Germany, West / Q000453:epidemiology; D006801:Humans; D011183:Postoperative Complications / Q000453:epidemiology / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D013105:Sphincterotomy, Transduodenal
Ist die einzeitige Cholezystektomie mit Choledochusrevision obsolet?