[Management of common bile duct stones--Results of a nationwide survey with analysis of 8 433 common bile duct explorations in Germany].
BACKGROUND
Aim of this study was the evaluation of the management of choledocholithiasis and outcome of laparoscopic as well as open cholecystectomy in Germany.


METHODS
A written questionnaire was sent to 449 randomly selected German surgeons annually from 1991 to 1994 and additionally to all German university hospitals until 1998.


RESULTS
A total of 98 482 operations for gallstone disease including 86 485 cholecystectomies (non-university hospitals 1991-1993: n = 60 246, university hospitals 1991-1996: n = 26 239) and 8 433 common bile duct (CBD) explorations (non-university hospitals: n = 6 919, university hospitals: n = 1 514) with or without cholecystectomy were reported. The overall complication rate for CBD explorations was 13.2 % (non-university hospitals) and 15.1 % (university hospitals), the overall hospital mortality rate was 0.64 % (non-university hospitals) and 0.58 % (university hospitals, n. s.). When choledocholithiasis was suspected, in 1998 all university hospitals used a two-stage management with preoperative ERC. In case of diagnosed isolated choledocholithiasis 93 % usually chose an endoscopic approach. When simultaneous cholecysto-choledocholithiasis was diagnosed preoperatively 86 % of the university hospitals used a two-stage management with preoperative ERC and stone extraction and secondary cholecystectomy (1991: 45 %). The percentage of CBD explorations decreased continuously from 7.4 % in 1991 to 3.8 % in 1996 (p < 0.01).


CONCLUSIONS
These results allow for the estimation of frequency and overall risks in surgical therapy of CBD stones. At the moment, laparoscopic CBD exploration does not play a significant role in Germany. Data show a trend to the two-stage "therapeutical splitting" with lower complication rates.
Hüttl
Th P
TP
Chirurgische Klinik und Poliklinik, Klinikum Grosshadern der Universität München, Germany. thomas.huettl@gch.med.uni-muenchen.de
Hrdina
Ch
Ch
Geiger
T K
TK
Meyer
G
G
Schildberg
F W
FW
Krämling
H J
HJ
D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000706:statistics & numerical data; D002763:Cholecystectomy / Q000706:statistics & numerical data*; D017081:Cholecystectomy, Laparoscopic / Q000706:statistics & numerical data*; D042882:Gallstones / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D005858:Germany; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D011183:Postoperative Complications / Q000401:mortality / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D015996:Survival Rate