Management of common bile duct stones in a single operation combining laparoscopic cholecystectomy and peroperative endoscopic sphincterotomy.
The diagnosis and treatment strategy to apply to common bile duct stones (CBDS) is always a controversial subject. The aim of this study was to evaluate the treatment of CBDS in a "one-stage" operation by laparoscopic cholecystectomy (LC) and peroperative endoscopic sphincterotomy (ES). Between January 1994 and April 2000, 60 patients, 24 men and 36 women (sex ratio, 1.5), with a median age of 57 years (range, 26 to 84 years), were treated for suspected or confirmed CBDS. The CBDS were uncomplicated in 53 patients (88%) and associated with a complication in 7 patients (12%); namely, cholangitis (in 3 patients) and acute pancreatitis (in 4 patients). The peroperative ES was performed immediately after the LC during the same operative time, with peroperative cholangiography being systematically performed. The mean operative time for LC was 60 min (range, 40-90 min). The general anesthesia was prolonged by 40 min in order to perform an ES (range, 30-60 min), including the time required for endoscopic equipment installation. The peroperative ES was unsuccessful in 2 patients (3%) due to the impossibility of catheterizing the papilla. In the first patient, postoperative ES was successful. In the second patient, the small CBDS was left to pass spontaneously. In 1 patient, because of multiple calculi in the CBD, open surgery was performed immediately after the ES. In 2 patients, a residual stone was found by cholangiography on the sixth postoperative day, and spontaneous evacuation occurred 2 weeks later. Final ductal clearance was achieved in 100% of the patients. There was no mortality and the incidence of postoperative minor complications was 3% (2 patients). The duration of postoperative hospitalization was 4.6 days (range, 3-11 days). The one-stage treatment procedure is, to us, an alternative to the minimally invasive treatment of CBDS. This method is rapid, reliable, and safe. It now needs to be evaluated in larger studies, keeping in mind that the limiting characteristic is the proximity and the availability of the endoscopic team.
Service de Chirurgie Générale et Digestive, Centre de Chirurgie Viscérale, d'Urgence et de Transplantation, Hôpitaux Universitaires de Strasbourg, Hautepierre, Avenue Molière, 67098 Strasbourg Cedex, France.
Christian
C
Meyer
Jacques Vo Huu
JV
Le
Serge
S
Rohr
Bernard
B
Duclos
Jean-Marie
JM
Reimund
Rene
R
Baumann
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D005260:Female; D042882:Gallstones / Q000601:surgery*; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D016717:Sphincterotomy, Endoscopic / Q000379:methods*; D016896:Treatment Outcome