title: Treatment of common bile duct stones in Sweden 1989-2006: an observational nationwide study of a paradigm shift.
abstract: BACKGROUND
  The preferred strategies for treatment of common bile duct stones have changed from choledochotomy with cholecystectomy to sphincterotomy with or without cholecystectomy. The aim of the present study was to compare the effectiveness of these treatment strategies on a nationwide level in Sweden.
  
  
  METHODS
  All patients with hospital care for benign biliary diagnoses 1988-2006 were identified in Swedish registers. Patients with common bile duct stones and a first admission with choledochotomy and or endoscopic sphincterotomy from 1989 through 2006 comprised the study group. These patients were analyzed with respect to readmission for biliary diagnoses and acute pancreatitis.
  
  
  RESULTS
  Incidence of open and laparoscopic choledochotomy decreased from 19.4 to 5.2, whereas endoscopic sphincterotomy increased from 5.1 to 26.1 per 100,000 inhabitants per year, respectively. Among patients treated for common bile duct stones (n = 26,815), 60.0 % underwent cholecystectomy during the first hospital admission in 1989-1994, compared to 30.1 % in 2001-2006. The treatment strategy that included endoscopic sphincterotomy was associated with more readmissions for biliary diagnoses and increased risk for acute pancreatitis than the treatment strategy with choledochotomy. However, patients treated with endoscopic sphincterotomy and concurrent cholecystectomy at the index admission had the lowest risk of readmission.
  
  
  CONCLUSIONS
  Cholecystectomy has been increasingly separated from treatment of bile duct stones, and endoscopic sphincterotomy has superseded choledochotomy as a first alternative for bile duct clearance in Sweden. In patients fit for surgery, clearance of the common bile duct can be combined with cholecystectomy, as it probably reduces the need for biliary related readmissions.
authors.affiliation: Department of Surgical and Perioperative Sciences, Surgery, Umeå University, SE-901 85, Umeå, Sweden. birger.sandzen@vll.se
authors.forename: Birger
authors.initials: B
authors.lastname: Sandzén
authors.forename: Markku M
authors.initials: MM
authors.lastname: Haapamäki
authors.forename: Erik
authors.initials: E
authors.lastname: Nilsson
authors.forename: Hans C
authors.initials: HC
authors.lastname: Stenlund
authors.forename: Mikael
authors.initials: M
authors.lastname: Oman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D002763:Cholecystectomy / Q000009:adverse effects / Q000706:statistics & numerical data* / Q000639:trends; D003135:Common Bile Duct / Q000601:surgery*; D005260:Female; D042882:Gallstones / Q000150:complications / Q000628:therapy*; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000453:epidemiology / Q000209:etiology; D010359:Patient Readmission / Q000706:statistics & numerical data; D012042:Registries; D016717:Sphincterotomy, Endoscopic / Q000009:adverse effects / Q000706:statistics & numerical data* / Q000639:trends; D013548:Sweden / Q000453:epidemiology; D016896:Treatment Outcome; D055815:Young Adult