Surgical versus endoscopic treatment of bile duct stones

Martín, David; Vernon, D. R.; Toouli, James

doi:10.1002/14651858.cd003327.pub2

Cited by 215 publications

(255 citation statements)

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“…Despite a recent Cochrane review and a metaanalysis showing comparable results between the two strategies, experience and expertise for the widespread use of laparoscopic CBD exploration still are lacking [11,12]. Thus, in many countries, patients who undergo ES for CBD-stones are subsequently scheduled for cholecystectomy.…”

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confidence: 99%

Timing of cholecystectomy after endoscopic sphincterotomy for common bile duct stones

et al. 2008

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Background According to the literature, the conversion rate for laparoscopic cholecystectomy (LC) after endoscopic sphincterotomy (ES) for cholecystodocholithiasis reaches 20%, at least when LC is performed 6 to 8 weeks afterward. It is hypothesized that early planned LC after ES prevents recurrent biliary complications and reduces operative morbidity and hospital stay. Methods All consecutive patients who underwent LC after ES between 2001 and 2004 were retrospectively evaluated. Recurrent biliary complications during the waiting time for LC, conversion rate, postoperative complications, and hospital stay were documented. Results This study analyzed 167 consecutive patients (59 men) with a median age of 54 years. The median interval between ES and LC was 7 weeks (range, 1-49 weeks). During the waiting time for LC, 33 patients (20%) had recurrent biliary complications including cholecystitis (n = 18, 11%), recurrent choledocholithiasis (n = 9, 5%), cholangitis (n = 4, 2%), and biliary pancreatitis (n = 2, 1%). Of these 33 patients, 15 underwent a second endoscopic retrograde cholangiography (ERC). The median time between ES and the development of recurrent complications was 22 days (range, 3-225 days). Most of the biliary complications (76%) occurred more than 1 week after ES. Conversion to open cholecystectomy occurred for 7 of 33 patients with recurrent complications during the waiting period, compared with 13 of 134 patients with an uncomplicated waiting period (p = 0.14). This concurred with doubled postoperative morbidity (24% vs 11%; p = 0.09) and a longer hospital stay (median, 4 vs 2 days; p \ 0.001). Conclusion In this retrospective analysis, 20% of all patients had recurrent biliary complications during the waiting period for cholecystectomy after ES. These recurrent complications were associated with a significantly longer hospital stay. Cholecystectomy within 1 week after ES may prevent recurrent biliary complications in the majority of cases and reduce the postoperative hospital stay.Keywords Biliary complications Á Cholecystectomy Á Common bile duct Á Conversion rate Á Endoscopic sphincterotomyOf the patients presenting with cholecystolithiasis, 4% to 15% have concomitant common bile duct (CBD) stones [1][2][3]. The current standard of treatment for symptomatic

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confidence: 99%

Timing of cholecystectomy after endoscopic sphincterotomy for common bile duct stones

et al. 2008

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“…In a multicenter prospective randomised trial, published more than a decade ago, Cuschieri et al demonstrated that preoperative endoscopic clearance of CBD followed by laparoscopic cholecystectomy was comparable to one-stage laparoscopic cholecystectomy and CBD exploration in terms of success rate, morbidity and mortality [9]. This has further been proved in subsequent studies [13,14]. The hospital stay and the total treatment cost were, however, significantly less with the one-stage laparoscopy group prompting the authors to recommend the latter as the procedure of choice [9,10].…”

Section: Discussionmentioning

confidence: 91%

‘Single-Sitting’ Laparoscopic Cholecystectomy and Endoscopic Removal of Common Bile Duct Stone for Cholelithiasis and Choledocholithiasis: a Feasibility Study

Ibrarullah¹,

Mishra²,

Dash³

et al. 2013

Indian J Surg

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'Single-sitting' laparoscopic cholecystectomy followed by endoscopic common bile duct clearance is emerging as a viable option for management of cholelithiasis and concomitant choledocholithiasis. The only disadvantage of the procedure is logistical since it requires co-ordination between two teams-the surgeons and the endoscopists. This limitation can be overcome in centres where both the procedures are performed by one team. With a considerable experience in endoscopy, we conducted a prospective study in a select group of patients to assess the feasibility of this single-sitting approach. The study included 38 patients with a radiological diagnosis of choledocholithiasis or jaundice at presentation. After laparoscopic cholecystectomy, the patients were turned prone and subjected to endoscopic retrograde cholangiogram, sphincterotomy and extraction of the common bile duct stone. The procedure was successful in 33 (87 %) of patients. The mean procedure time and hospital stay were 2 h, 20 min and 2 days, respectively. None of the patients had any major complications. We conclude that in a select group of patients, single-sitting laparoscopic cholecystectomy followed by endoscopic clearance of the common bile duct stone is safe and effective.Keywords Choledocholithiasis . CBD Stone . Laparoscopic Cholecystectomy Common bile duct (CBD) stone occurs in about 3-15 % of patients undergoing laparoscopic cholecystectomy (LC) [1][2][3]. In the era of open cholecystectomy, preoperative endoscopic clearance of CBD followed by open cholecystectomy was comparable [4][5][6] or even considered inferior [7] to single-stage cholecystectomy and choledocholithotomy. With minimally invasive surgery becoming the 'gold standard,' the endoscopic approach has seen a revival and has been considered a viable alternative to laparoscopic CBD exploration for concomitant CBD stone. Traditionally, gallstones with CBD stones are managed in two sittings i.e., endoscopic clearance of CBD stone followed by laparoscopic cholecystectomy or vice versa [8]. This entails involvement of two teams led by the endoscopist and surgeon for CBD stones and gallstones, respectively. The endoscopic approach has been found to be similar to laparoscopic CBD exploration in terms of successful stone clearance, morbidity, and mortality except for longer hospital stay [9,10]. The latter disadvantage can be countered by carrying out the endoscopic CBD stone clearance as a single-sitting procedure in conjunction with LC [11]. The single-sitting approach, however, suffers from the logistic problem as it requires proper coordination between the surgeon and the endoscopist. We were encouraged to try this approach because of our considerable experience with both laparoscopy as well as endoscopy. We attempted to perform laparoscopic cholecystectomy as well as endoscopic clearance of the CBD stone ourselves without having the need to involve another team. In this report, we have presented our initial experience with this 'single-sitting' approach with respect to its...

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“…A Cochrane systematic review by Martin et al [3] concluded that a single-stage treatment of bile duct stones via the cystic duct approach was recommended for intraoperatively discovered CBD stones. In patients where it is not possible to clear the duct by this approach, a delayed postoperative ES should be the preferred option in most centers.…”

Section: Stones Discovered Intraoperativelymentioning

confidence: 99%

“…From 10 % to 18 % of patients undergoing Laparoscopic Cholecystectomy (LC) for gallbladder stones have synchronous CBD stones [2,3]. These should be treated even if asymptomatic [4].…”

Section: Introductionmentioning

confidence: 99%

Management of Common Bile Duct Stones in the Laparoscopic Era

et al. 2012

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There is no consensus regarding the ideal management of concurrent gallbladder and common bile duct (CBD) stones. Currently the treatment protocol involves most commonly a sequential approach consisting of endoscopic sphincterotomy followed by laparoscopic cholecystectomy or a single stage laparoscopic procedure, including cholecystectomy and exploration of the CBD. For this article literature search was performed using online search engines, Google, Pubmed, the online Springer link library and the Cochrane Database Systematic Review. Review articles, prospective and retrospective studies which detailed or compared the various treatment strategies for CBD stones were selected and analyzed. This review article aims to provide an insight into the optimal management of CBD stones in different clinical scenarios. Endoscopic sphincterotomy has inherent morbidity and complications like CBD stone recurrence whereas laparoscopic CBD exploration demands considerable expertise which is available only at specialized centres. The clinical presentation of the patient, number of stones, size of CBD, available resources and technical expertise at hand are an important consideration for the ideal management in different scenarios.

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Surgical versus endoscopic treatment of bile duct stones

Cited by 215 publications

References 89 publications

Timing of cholecystectomy after endoscopic sphincterotomy for common bile duct stones

Timing of cholecystectomy after endoscopic sphincterotomy for common bile duct stones

‘Single-Sitting’ Laparoscopic Cholecystectomy and Endoscopic Removal of Common Bile Duct Stone for Cholelithiasis and Choledocholithiasis: a Feasibility Study

Management of Common Bile Duct Stones in the Laparoscopic Era

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