Two-stagevssingle-stage management for concomitant gallstones and common bile duct stones

Lu, Jiong; Cheng, Yao; Xiong, Xian‐Ze; Lin, Yixin; Wu, Sijia; Cheng, Nan‐Sheng

doi:10.3748/wjg.v18.i24.3156

Cited by 142 publications

(106 citation statements)

References 42 publications

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“…Postoperative minor complications occurred in three patients (12.5%): mild pancreatitis with elevation of serum amylase in two patients and minor bile leak in one patient; no mortality, nearly in agreement with several studies that reported morbidity and mortality rates of 5-11 and 8-12%, respectively [9].…”

Section: Discussionsupporting

confidence: 74%

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Single-Session Treatment of Cholecysto-Choledocholithiasis: Totally Laparoscopic versus Laparo-Endoscopic

Sayed¹

2017

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Abstract:Background: This study details Assiut and South Valley universities experience in treating combined gall bladder and common bile duct stones in a single session, either with Endoscopic Retrograde Cholangio-Pancreatography (ERCP) for Common Bile Duct (CBD) stone extraction followed by laparoscopic cholecystectomy (LC), or totally laparoscopic treatment. Patients and methods: In this prospective randomized study, 46 consecutive patients with confirmed cholecystocholedocholithiasis were randomized to 2 groups. Group (A) included 24 patients treated with single-session ERCP for CBD stone extraction and laparoscopic cholecystectomy [ERCP-LC]. Group (B) included 22 patients treated with laparoscopic CBD exploration and laparoscopic cholecystectomy [LCBDE-LC]. Demographic data, operative time, CBD clearance success rate, short term complications and duration of hospital stay were recorded. Results: Patients included 28 females and 18 males with mean age of 42.1 ± 12.1 years (range 17 -71 years). In 22/24 patients (91.7%) ERCP-LC was done successfully. Mean operative time was 105 ± 19.1 minutes (50-150 min.). No intra-operative complications occurred. Early post-operative complications occurred in 3 patients (12.5%). Mean hospital stay was 2.1 ± 0. 91 days (1-6 days). In the other group, LCBDE-LC was performed successfully in 22/22 patients (100%). Mean operative time was 145 ± 23 minutes (100-180 min.). Minor intra-operative complications (bleeding) occurred in 2/22 cases (9%). Minor early post-operative complications (bile leak, ileus, bleeding) occurred in 4/22 patients (18%). Mean hospital stay was 2.8 ± 0.83 days (2-7 days). Conclusion: Single session ERCP-LC and LCBDE-LC procedures for management of cholecysto-choledocholithiasis are feasible, safe, and effective and have comparable outcome regarding success rate, peri-operative complications. ERCP-LC has statistically significant less operative time and less hospital stay.

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Section: Discussionsupporting

confidence: 74%

“…A similar study carried out by Alexakis and Connor denoted a success rate of 80-91% [15]. In another study by Lu et al, success rates of 89-95% were reported [9]. Dasari et al reported success rate in 72/81 (91%) patients [16].…”

Section: Discussionmentioning

confidence: 62%

Single-Session Treatment of Cholecysto-Choledocholithiasis: Totally Laparoscopic versus Laparo-Endoscopic

Sayed¹

2017

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“…Over these years, randomized controlled trials showed superior outcome with LCBDE compared with endoscopic or OCBDE treatment for CBD stones. It is associated with a high stone clearance rate ranging from 84-97 %, a postoperative morbidity rate of 4-16 %, and a mortality rate of approximately 0-0.8 % [8,9].…”

Section: Discussionmentioning

confidence: 99%

Primary Closure Following Laparoscopic Common Bile Duct Reexploration for the Patients Who Underwent Prior Biliary Operation

et al. 2016

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To assess feasibility of primary closure following laparoscopic common bile duct reexploration for the patients who underwent prior biliary operation, we retrospectively studied 50 patients with recurrent or residual common bile duct (CBD) stones who underwent laparoscopic biliary reoperation between June 2008 and June 2013. Endoscopic sphincterotomy (EST) was treated for all these patients and validated failed. They were divided into two groups. Primary closure following laparoscopic common bile duct exploration (LCBDE) was performed in 25 cases (group A); LCBDE plus T-tube drainage was performed in others (group B). The items of operation were compared. The duration of the operation in group A was shorter than that in group B (141 ± 85 vs 158 ± 71 min, p < 0.05), as was postoperative hospital stay (16 ± 2.3 vs 23 ± 2.3 h, p < 0.05) and the times of postoperative gastrointestinal function recovery (16 ± 2.3 vs 23 ± 2.3 h, p < 0.05). Just one duodenum was damaged in group B. Postoperative clinically significant bile leakage occurred in two patients in group A and one case in group B. The median follow-up was 18 months. No postoperative pancreatitis, postoperative bleeding, bile peritonitis after T-tube removal, stricture of bile duct, and death occurred in the two groups. Just two cases in group B were verified residual stones after 1 month. Primary closure following laparoscopic common bile duct reexploration for the patients who underwent prior biliary operation appears to be a minimally invasive, safe, feasible, and effective procedure when done by expert laparoscopic surgeons.

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“…Indeed, one recent prospective trial comparing LCBDE and open surgery confirmed the superiority of the laparoscopic method in terms of efficiency, morbidity and mortality [78] . When comparing the two-stage (LC with preoperative or postoperative ERCP) and single-stage (LC with LCBDE), no significant differences were found, except for some intrinsic characteristics (fewer therapeutic sessions) [79,80] . Another trial [81] reported having a reduced hospital stay when using LCBDE.…”

Section: Concomitant Laparoscopic Cholecystectomy and Common Bile Ducmentioning

confidence: 97%

Modern approach to cholecysto-choledocholithiasis

Bencini¹

2014

WJGE

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Gallstones and common bile duct calculi are found to be associated in 8%-20% of patients, leading to possible life-threatening complications, such as acute biliary pancreatitis, jaundice and cholangitis. The gold standard of care for gallbladder calculi and isolated common bile duct stones is represented by laparoscopic cholecystectomy and endoscopic retrograde cholangiopancreatography, respectively, while a debate still exists regarding how to treat the two diseases at the same time. Many therapeutic options are also available when the two conditions are associated, including many different types of treatment, which local professionals often administer. The need to limit maximum discomfort and risks for the patients, combined with the economic pressure of reducing costs and utilizing resources, favors single-step procedures. However, a multitude of data fail to strongly demonstrate the superiority of any technique (including a two or multi-step approach), while rigorous clinical trials that include so many different types of treatment are still lacking, and it is most likely unrealistic to conduct them in the future. Therefore, the choice of the best management is often led by the local presence of professional expertise and resources, rather than by a real superiority of one strategy over another.

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Two-stagevssingle-stage management for concomitant gallstones and common bile duct stones

Abstract: Single-stage management is equivalent to two-stage management but requires fewer procedures. However, patient's condition, operator's expertise and local resources should be taken into account in making treatment decisions.

Cited by 142 publications

References 42 publications

Single-Session Treatment of Cholecysto-Choledocholithiasis: Totally Laparoscopic <i>versus</i> Laparo-Endoscopic

Single-Session Treatment of Cholecysto-Choledocholithiasis: Totally Laparoscopic <i>versus</i> Laparo-Endoscopic

Primary Closure Following Laparoscopic Common Bile Duct Reexploration for the Patients Who Underwent Prior Biliary Operation

Modern approach to cholecysto-choledocholithiasis

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Two-stagevssingle-stage management for concomitant gallstones and common bile duct stones

Abstract: Single-stage management is equivalent to two-stage management but requires fewer procedures. However, patient's condition, operator's expertise and local resources should be taken into account in making treatment decisions.

Cited by 142 publications

References 42 publications

Single-Session Treatment of Cholecysto-Choledocholithiasis: Totally Laparoscopic &lt;i&gt;versus&lt;/i&gt; Laparo-Endoscopic

Single-Session Treatment of Cholecysto-Choledocholithiasis: Totally Laparoscopic &lt;i&gt;versus&lt;/i&gt; Laparo-Endoscopic

Primary Closure Following Laparoscopic Common Bile Duct Reexploration for the Patients Who Underwent Prior Biliary Operation

Modern approach to cholecysto-choledocholithiasis

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Product

Resources

About

Single-Session Treatment of Cholecysto-Choledocholithiasis: Totally Laparoscopic <i>versus</i> Laparo-Endoscopic

Single-Session Treatment of Cholecysto-Choledocholithiasis: Totally Laparoscopic <i>versus</i> Laparo-Endoscopic