Comparison of laparoscopic common bile duct exploration and endoscopic retrograde cholangiopancreatography plus laparoscopic cholecystectomy for choledocholithiasis: a prospective randomized study

doi:10.1016/j.amjsurg.2013.02.004

The American Journal of Surgery

Volume 206, Issue 4, October 2013, Pages 457-463

https://doi.org/10.1016/j.amjsurg.2013.02.004 Get rights and content

Abstract

Background

Endoscopic retrograde cholangiopancreatography and laparoscopic common bile duct exploration are safe and efficient methods that have recently been used for the treatment of bile duct stones. The aim of this study was to compare the efficacy, safety, and surgical outcomes of the laparoscopic common bile duct exploration plus laparoscopic cholecystectomy (LCBDE+LC) and endoscopic retrograde cholangiopancreatography plus laparoscopic cholecystectomy (ERCP+LC).

Methods

One hundred twenty patients were prospectively randomized into 2 groups: LCBDE with LC in a single intervention and LC after ERCP.

Results

The success rate of the LCBDE+LC group (96.5%) was found to be higher than for the ERCP+LC group (94.4%). Complication rates of the LCBDE+LC and ERCP+LC group were 7% and 11.1%, respectively. Complications requiring ERCP in the postoperative period after LCBDE+LC have been noted in 3.5% of cases.

Conclusions

Laparoscopic CBD exploration provides an alternative therapeutic approach that has less morbidity, is cost-effective, and allows earlier recovery with a reduced period of short-term disability.

Section snippets

Study population

This study was a randomized controlled trial comparing preoperative ERCP followed by laparoscopic cholecystectomy (LC) with LCBDE for choledocholithiasis treatment. A total of 120 patients with gallstones concomitant with CBD stones underwent surgery between January 2008 and September 2010. They were divided into 2 groups and each group consisted of 60 patients. Patients were selected from among a good risk population, with classic signs and symptoms of gallstone disease in Okmeydanı Training

Results

A total of 120 patients were randomized for the treatment of CBD stones. Sixty patients were randomized to LCBDE+LC (group 1) and 60 patients were randomized to endoscopic retrograde cholangiopancreatography sphincterotomy (ERCP)+LC (group 2). Nine patients had protocol violations and were excluded from outcome analysis: 3 in the LCBDE+LC group, 6 in the ERCP/S+LC group. CBD stones could not be detected for 3 patients in each group, and these patients were excluded from the study. Three

Comments

Choledocholithiasis causes gallstone pancreatitis, bile duct obstruction, and cholangitis. Moreover, with an incidence rate of 5% to 15% of patients with gallbladder stones, it is the 2nd most common complication after acute cholecystitis.¹⁰ Furthermore, this incidence of CBD stones increased up to 20% in elderly patients.11, 12 CBD stones are responsible for considerable morbidity and mortality from complications including pancreatitis, cholangitis, and hepatic dysfunction. To prevent these

Conclusions

Various therapeutic options are available for managing choledocholithiasis. The results demonstrate that the ductal stone clearance rate was equivalent in LCBDE and ERCP. However, for patients with CBD stones along with severe comorbid diseases and for emergency patients, ERCP was considered a 1st strategy. In experienced hands, LCBDE is a safe and feasible option with the advantages of minimal access and preservation of sphincter anatomic functions.

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Comparison of laparoscopic common bile duct exploration plus cholecystectomy and endoscopic retrograde cholangiopancreatography followed by laparoscopic cholecystectomy for elderly patients with common bile duct stones and gallbladder stones
2024, Journal of Gastrointestinal Surgery
Common bile duct (CBD) stones commonly occur in cholecystectomy cases. The management options include laparoscopic CBD exploration (LCBDE) or endoscopic retrograde cholangiopancreatography (ERCP) followed by laparoscopic cholecystectomy (LC). Although ERCP is fully developed, it has complications, and LCBDE is a proven alternative. This study aimed to evaluate the safety and efficacy of these treatments in elderly individuals aged ≥70 years.
A retrospective study between January 2015 and July 2022 included 160 elderly patients (aged ≥70 years) diagnosed with cholelithiasis and choledocholithiasis. The patients were divided into 1-stage (LCBDE [n = 80]) or 2-stage (ERCP followed by LC [n = 80]) treatment groups. Data collected encompassed comorbidities, symptoms, bile duct clearance, postoperative complications, and long-term outcomes for systematic analysis.
This study analyzed 160 patients treated for CBD stones, comparing 1-stage and 2-stage groups. The 1-stage group had more female patients than the 2-stage group (57.5% vs 37.5%, respectively). The 1-stage group had a mean age of 80.55 ± 7.00 years, which was higher than the mean age in the 2-stage group. American Society of Anesthesiologists classification, Charlson Comorbidity Index, and laboratory findings were similar. Pancreatitis and cholangitis occurred after ERCP in the 2-stage group. Stone clearance rates (92.35% [1-stage group] vs 95.00% [2-stage group]) and biliary leakage incidence (7.5% [1-stage group] vs 3.0% [2-stage group]) were similar, as were postoperative complications and long-term recurrence rates (13.0% [1-stage group] vs 12.5% [2-stage group]).
Our research indicates that both the combination of LCBDE and LC and the sequence of ERCP followed by LC are equally efficient and secure when treating CBD stones in elderly patients. Consequently, the 1-stage procedure may be considered the preferred treatment approach for this demographic.
One-step percutaneous transhepatic cholangioscopic lithotripsy in patients with choledocholithiasis
2021, Clinics and Research in Hepatology and Gastroenterology
Endoscopic retrograde cholangiopancreatography (ERCP) may be inappropriate for most patients with choledocholithiasis. This study aimed to evaluate one-step percutaneous transhepatic cholangioscopic lithotripsy (PTCSL) in the treatment of patients with choledocholithiasis who could not undergo ERCP (e.g., failed ERCP, altered anatomy, and/or contra-indications).
This was a retrospective single-centre series of 67 patients who underwent choledocholithiasis between November 2015 and March 2018: 35 with one-step PTCSL (Group A) and 32 with laparoscopic common bile duct (CBD) exploration (Group B).
Compared with Group B, Group A showed shorter duration of operation, length of stay in the hospital, postoperative hospital stay, postoperative drainage time, and time to oral intake (all P < 0.05). Intraoperative blood loss, costs, conversion to open surgery (one in group A vs. seven in group B; P = 0.023), and bile leakage (none in group A vs. four in group B; P = 0.047) were lower in Group A than in Group B. There were no significant differences between the two groups regarding the intraoperative clearance rate, ultimate clearance rate, and several postoperative complications.
One-step PTCSL could be an alternative for patients with choledocholithiasis, especially when ERCP is not feasible.
Dormia basket impacted during ERCP, resolved by laparoscopic bile duct approach: Case report
2021, International Journal of Surgery Case Reports
Endoscopic retrograde cholangiopancreatography (ERCP) is the method of choice for treating and removing common bile duct (CBD) stones with high success rates. Among the adverse effects, impaction of the Dormia basket when removing the stones is an unusual complication.
Two cases of choledocholithiasis with endoscopic treatment by ERCP and Dormia basket impaction, resolved by a laparoscopic approach to the bile duct.
Laparoscopic common bile duct exploration (LCBDE) has been developed as a technique to treat choledocholithiasis and simultaneously vesicular lithiasis by laparoscopy. LCBDE can be by means of a transcystic approach or by choledochotomy. The success of the treatment depends on surgical experience and the availability of adequate equipment, with high effectiveness to eliminate CBD stones and a success rate greater than 95%, it is equally effective for the resolution of adverse events during ERCP.
LCBDE provides an alternative therapy where there is no other type of treatment for the resolution of complications of ERCP. It is a safe, effective and reliable technique with high success rates, which offers the benefits of a minimally invasive approach.
Index admission vs elective laparoscopic common bile duct exploration: a district general hospital experience over 6 years
2024, Langenbeck's Archives of Surgery
The efficacy and safety of laparoscopic common bile duct exploration with primary duct closure for cholecystolithiasis combined with choledocholithiasis
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One-step laparoscopic cholecystectomy with common bile duct exploration and stone extraction versus two-step endoscopic retrograde cholangiography with stone extraction plus laparoscopic cholecystectomy for patients with common bile duct stones: a randomised feasibility and pilot clinical trial—the preGallStep trial
2023, Pilot and Feasibility Studies

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: The authors declare no conflicts of interest.

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Clinical ScienceComparison of laparoscopic common bile duct exploration and endoscopic retrograde cholangiopancreatography plus laparoscopic cholecystectomy for choledocholithiasis: a prospective randomized study

Abstract

Background

Methods

Results

Conclusions

Section snippets

Study population

Results

Comments

Conclusions

Baillieres Clin Gastroenterol

J Gastrointest Surg

Lancet

Am J Surg

Cholelithiasis and cholecystitis

J Long Term Eff Med Implants

Choledocholithiasis: evolving intraoperative strategies

Am Surg

Laparoscopic choledocholithotomy

J Laparoendosc Surg

Laparoscopic approach to common duct pathology

Surg Laparosc Endosc

E.A.E.S. multicenter prospective randomized trial comparing two-stage vs single-stage management of patients with gallstone disease and ductal calculi

Surg Endosc

Combined endoscopic treatment for cholelithiasis associated with choledocholithiasis

Surg Endosc

Surgery vs endoscopy as primary treatment in symptomatic patients with suspected common bile duct stones: a multicenter randomized trial. French Associations for Surgical Research

Arch Surg

Current dilemmas in management of common duct stones

Surg Endosc

Laparoscopic common bile duct exploration for elderly patients: as a first treatment strategy for common bile duct stones

J Korean Surg Soc

Effectiveness and long-term results of laparoscopic common bile duct exploration

Surg Endosc

Laparoscopic treatment for choledocholithiasis: a prospective evaluation in 247 consecutive unselected patients

Hepatogastroenterology

Clinical Science
Comparison of laparoscopic common bile duct exploration and endoscopic retrograde cholangiopancreatography plus laparoscopic cholecystectomy for choledocholithiasis: a prospective randomized study