[Does laparoscopy influence the treatment of choledocholithiasis?].
Operative common bile duct exploration, performed in conjunction with cholecystectomy, used to be considered the treatment of choice for choledocholithiasis in the presence of an intact gallbladder. The advent of laparoscopic cholecystectomy (LC) has affected the management of common bile duct stones. More emphasis is placed on preoperative intravenous cholangiography (IVC) and endoscopic retrograde cholangiography (ERC) with endoscopic papillotomy (EP) either just before or soon after laparoscopic surgery. This involves the patient in an additional procedure with its associated risks. Single-stage treatment of biliary lithiasis, i.e. LC and laparoscopic common bile duct exploration (LCDE) appears preferable to two-stage treatment, especially when the ampulla of Vater can be preserved. 550 consecutive patients with LC are reviewed. IVC with tomography was performed in 341 of these patients without complications and with a sensitivity of 75% and a specificity of 99%. The procedure failed in 5.6% due to poor quality imaging, and was contraindicated in 21 patients. With increasing laparoscopic experience, intraoperative cholangiography (IOC) was adopted and has been used routinely since November 1992. IOC was successful in 204 of 209 attempts (97.6%) with a sensitivity of 95% and a specificity of 100%. The mean operation time for IOC was 10 minutes. Unsuspected bile duct stones were found in 6% of instances. IOC demonstrated one choledochotomy (0.18% of all LC), thus preventing transsection of the duct. 47 patients (8.5%) had common duct stones. 29 (62%) were treated by ERC and EP, while 18 (38%) underwent LCDE. Successful clearance was achieved endoscopically in 94% and laparoscopically in 82% of the attempts.(ABSTRACT TRUNCATED AT 250 WORDS)
Tschudi
J
J
Chirurgische Abteilung, Spital Aarberg.
Triaca
H
H
Germiquet
F
F
Klaiber
C
C
D002758:Cholangiography / Q000379:methods; D002760:Cholangiopancreatography, Endoscopic Retrograde; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D005260:Female; D042882:Gallstones / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D016717:Sphincterotomy, Endoscopic
Beeinflusst die Laparoskopie die Behandlung der Choledocholithiasis?