title: One-stage versus two-stage management for concomitant gallbladder stones and common bile duct stones in patients with obstructive jaundice.
abstract: No consensus exists regarding the optimal management of concomitant gallbladder stones and common bile duct stones (CBDS). Previous studies showed a significant association between the presence of obstructive jaundice and increased risk of postoperative complications and conversion to open surgery. This retrospective study evaluated the effectiveness and safety of one-stage (laparoscopic cholecystectomy [LC] plus laparoscopic common bile duct exploration) management versus two-stage (preoperative endoscopic retrograde cholangiopancreatography/endoscopic sphincterotomy + LC) management for patients with obstructive jaundice, concomitant gallbladder stones, and CBDS. One-stage management (n = 88) or two-stage management (n = 122) was used for 210 eligible patients between January 2009 and March 2011. Both types of management proved to be effective and safe. No significant difference was observed in terms of stone clearance from the common bile duct (CBD), postoperative morbidity, mortality, or conversion to open surgery. However, one-stage management was more cost-effective and decreased the number of procedures. In addition, postoperative hospital stay and operative time were shorter for patients who received one-stage management. Especially for patients with CBD greater than 1 cm in diameter, one-stage management is a better choice.
authors.affiliation: Department of Bile Duct Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
authors.forename: Jiong
authors.initials: J
authors.lastname: Lu
authors.forename: Xian-Ze
authors.initials: XZ
authors.lastname: Xiong
authors.forename: Yao
authors.initials: Y
authors.lastname: Cheng
authors.forename: Yi-Xin
authors.initials: YX
authors.lastname: Lin
authors.forename: Rong-Xing
authors.initials: RX
authors.lastname: Zhou
authors.forename: Zhen
authors.initials: Z
authors.lastname: You
authors.forename: Si-Jia
authors.initials: SJ
authors.lastname: Wu
authors.forename: Nan-Sheng
authors.initials: NS
authors.lastname: Cheng
mesh_terms: D000328:Adult; D000368:Aged; D002760:Cholangiopancreatography, Endoscopic Retrograde; D017081:Cholecystectomy, Laparoscopic; D061887:Conversion to Open Surgery; D005260:Female; D042882:Gallstones / Q000150:complications* / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D041781:Jaundice, Obstructive / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016717:Sphincterotomy, Endoscopic; D016896:Treatment Outcome