title: [Preoperative therapeutic splitting].
abstract: BACKGROUND
  The best clinical strategy for using ERC combined with LC is still unknown. Based on a wide discussion of literature reports the aim of our study is to critically analyse laparoscopic bile duct exploration and to correlate these data to our prospective study of "therapeutical splitting".
  
  
  METHODS
  In a prospective study 1645 consecutive patients with sympomatic gall stone disease were examined by ultrasound. 309 patients had open cholecystectomy because of previous gastric surgery or perforation. Patients with a high probability of harbouring stones in the common duct or having other related disorders like biliary pancreatitis had ERC, EPT and stone extraction. 1336 patients had attempted LC.
  
  
  RESULTS
  At endoscopy 70% of the 260 patients required therapy like EPT and/or stone extraction, 95% consequently had their gallbladder removed laparoscopically. Including the patients with biliary pancreatitis morbidity amounted to 3% with no mortality. In the non-endoscopic group with 1076 patients conversion was 6.8%, morbidity was 4.3% and mortality 0.09%. Residual stones were found in 0.5% so far.
  
  
  CONCLUSIONS
  If selection criteria for bile duct pathology have a high sensitivity and specificity and endoscopical stone clearance rate is high, at present "therapeutical splitting" still is the method of choice.
authors.affiliation: I. Chirurgische Klinik, Landeskliniken Salzburg.
authors.forename: P
authors.initials: P
authors.lastname: Sungler
authors.forename: J
authors.initials: J
authors.lastname: Holzinger
authors.forename: P M
authors.initials: PM
authors.lastname: Heinerman
authors.forename: H W
authors.initials: HW
authors.lastname: Waclawiczek
authors.forename: O
authors.initials: O
authors.lastname: Boeckl
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002760:Cholangiopancreatography, Endoscopic Retrograde; D017081:Cholecystectomy, Laparoscopic; D003131:Combined Modality Therapy; D005260:Female; D042882:Gallstones / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D011446:Prospective Studies; D016896:Treatment Outcome; D014463:Ultrasonography
vernacular_title: Präoperatives therapeutisches Splitting.