Prospective evaluation of a minimally invasive approach for treatment of bile-duct calculi in the high-risk patient.
BACKGROUND
The best approach to bile duct stones in high-risk patients is controversial. We showed in a randomized trial that open surgery had a morbi-mortality similar to that of endoscopic sphincterotomy alone (ES) and less late biliary complications. The aim of this study was to evaluate a minimally invasive approach to duct stones in high-risk patients compared with open surgery or ES alone.


METHODS
Sixty high-risk patients (mean age 80 years) suspected of duct stones were treated by ES + laparoscopic cholecystectomy (LC). High-risk factors were: age > 70 years, Goldman cardiac index > 13, chronic pulmonary disease, liver cirrhosis, neurologic deficit, and severe obesity.


RESULTS
ERCP success was 87%. Duct stones were found in 75%. LC succeeded in 92%. Post-LC stay was 4 days. Overall morbidity was 19% and mortality was 3%. Recurrent symptoms (mean follow-up: 9 months) was 3.6%. When compared with open surgery or ES alone, ES + LC had a similar morbi-mortality, but shorter postop stay (p < 0.001). Late symptoms appeared in 20% after ES alone vs 4% after open surgery or ES plus LC (p < 0.04).


CONCLUSIONS
Combined ES + LC is an effective alternative to open surgery or ES alone for treatment of duct stones in high-risk patients.
Trias
M
M
Service of General and Digestive Surgery, Hospital Clinic, University of Barcelona, Villarroel 170, 08036 Barcelona, Spain.
Targarona
E M
EM
Ros
E
E
Bordas
J M
JM
Perez Ayuso
R M
RM
Balagué
C
C
Pros
I
I
Teres
J
J
D000368:Aged; D000369:Aged, 80 and over; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods / Q000401:mortality; D017081:Cholecystectomy, Laparoscopic / Q000379:methods* / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D042882:Gallstones / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D008297:Male; D011183:Postoperative Complications; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D016717:Sphincterotomy, Endoscopic / Q000379:methods* / Q000401:mortality; D015996:Survival Rate; D016896:Treatment Outcome