Sequential intraluminal endoscopic and laparoscopic treatment for bile duct stones associated with gallstones

Zaninotto, Giovanni; Costantini, Mario; Rossi, Mauro; Anselmino, Marco; Pianalto, S.; Oselladore, D.; Pizzato, D.; Norberto, Lorenzo; Ancona, Ermanno

doi:10.1007/bf00188519

Cited by 8 publications

(3 citation statements)

References 24 publications

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“…While traditional surgery remains the reference treatment, with well codified technique and good established results for more than 20 years, the current tendency is mainly towards minimally invasive methods with an exclusively laparoscopic approach to stone extraction, [2][3][4] or the multidisciplinary option called "sequential treatment", with ES combined with LC. [5][6][7][8][9][10][11] The results of the two techniques, recently published in a multicenter randomized study, are superimposable, with 90% stone clearance, mortality almost zero, and morbidity less than 10%. 12 Laparoscopic extraction techniques for CBDS, either via the transcystic or via the transcholedochal route, allow a one-stage minimally invasive treatment of CBDS.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, the rate of detection of CBDS during endoscopic retrograde cholangiography (ERC) is relatively low, varying between 50% and 60%. 7,8,10,11,13,14 The recent arrival of peroperative ES performed immediately after LC (one-session treatment) has the advantages of maintaining minimally invasive treatment, requiring only one operation for CBDS and one general anesthesia, and avoiding unnecessary ERC, [15][16][17][18] which is performed only in patients in whom CBDS have been confirmed with the peroperative cholangiography.…”

Section: Discussionmentioning

confidence: 99%

“…The postoperative hospital stay was 4.6 days. [3][4][5][6][7][8][9][10][11] This treatment for CBDS has been used by others: Basso et al, 21 (Table 3). It must be noted that peroperative ES increases the duration of anesthesia by only 30 to 60 min, as compared with isolated LC, 15,16,23 also counting the time required for the installation of endoscopic equipment and changing the patient's position.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Management of common bile duct stones in a single operation combining laparoscopic cholecystectomy and peroperative endoscopic sphincterotomy

Meyer

Rohr

et al. 2002

Journal of Hepato-Biliary-Pancreatic Surgery

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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.

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