[Changes in the treatment of choledocholithiasis].
The therapeutic approaches to gallstone disease and bile duct stone changed dramatically in the last decade by spreading of endoscopic and laparoscopic methods. The authors have reviewed the most frequent curing methods of bile duct stone recently. They examined patients treated for gallstone and common bile duct stone in Surgical Department and Gastroenterological Department of their hospital. Retrospective study was performed to evaluate the issue of treatment for gallstone disease in addition to common bile duct stone (CBDS) and papillary stenosis in the last six years from 1993 to 1998, in the era of laparoscopic cholecystectomy (LC). There was formed a control group from similar patients of these two departments, between 1986-1991, in the six-year period before the laparoscopic era. The postoperative complications and perioperative mortality were analysed in present period compared with the outcome of control group.


RESULTS
734 patients were treated by sequential endoscopic laparoscopic approach or open operation between 1993-1998: 632 endoscopic sphincterotomy (EST), from which 236 LC followed the preoperative EST, 102 open choledochotomy were performed. Overall complications were 4.4% and mortality was 0.9% (EST plus LC plus open operations.) The control group made up of 534 patients underwent a treatment of choledocholithiasis: 196 EST and 338 open choledochotomy were achieved. Complications were 10.6% and mortality was 1.9%. The authors statistically evaluate the retrospective results. They conclude that there is a significant difference in the complications rate between the two groups, but the decrease of mortality is not significant. The mean hospital stay is 6.5 days in the recent group and this value was 13.4 days in the control group. Saving of hospital cost is 62,100 Ft for one patients. The authors think that this sequential approach results in a safer and more effective treatment of cholecysto-choledocholithiasis than the former period's.
Tüske
G
G
Zala Megyei Kórház, Zalaegerszeg, Altalános Sebészeti Osztály.
Vattay
P
P
Csermely
L
L
Tárnok
F
F
D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D002760:Cholangiopancreatography, Endoscopic Retrograde; D017081:Cholecystectomy, Laparoscopic / Q000401:mortality; D005260:Female; D042882:Gallstones / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome