Preoperative Endoscopic Sphincterotomy and Laparoscopic Cholecystectomy for the Management of Cholecystocholedocholithiasis: 10-Year Experience |
| |
Authors: | Leopoldo Sarli Domenico R Iusco Luigi Roncoroni |
| |
Institution: | (1) Institute of General Surgery and Surgical Therapy, University of Parma, School of Medicine, Via Gramsci 14, 43100, Parma, Italy, |
| |
Abstract: | Abstract
No procedure has yet been identified as the “gold standard” for the detection and treatment of common bile duct stones (CBDS)
in patients undergoing laparoscopic cholecystectomy (LC). This prospective study involves 2137 patients undergoing elective
laparoscopic cholecystectomy. The algorithm for diagnostic management in place until July 1997 involved routine intravenous
cholangiography and selective endoscopic retrograde cholangiography (ERC). Subsequently, assessment of the bile duct was not
routinely performed, but a scoring system was applied to single out those patients at risk of CBDS who should undergo intravenous
cholangiography and/or ERC (see Fig. 2). Whenever bile duct stones were found, endoscopic sphincterotomy (ES) was performed,
and LC was performed with a standardized four-cannula technique after endoscopic bile duct stone clearance. Common bile duct
stones were suspected in 340 patients who were referred for preoperative ERC; 250 patients were referred for ES; 21 patients
were referred for open surgery because of failure of ERC or sphincterotomy. Common bile duct stones, detected in 283 cases
(13.2%), were removed before surgery in 250 cases (88.3%) and during surgery in 28 cases (9.9%). Self-limited pancreatitis
occurred in 4.2% of the patients after sphincterotomy. Laparoscopic cholecystectomy was performed in 98.4% of the cases. The
conversion rate was 8.3% if sphincterotomy had been performed previously and 3.4% after standard laparoscopic cholecystectomy
(p < 0.001). The morbidity rate was 4.5%; mortality, 0.09%. During follow-up five patients (0.2%) had retained stones endoscopically
treated. Future trials of novel strategies for detecting and treating CBDS should compare the results of novel strategies
with those of the strategy employed in this study, which includes selective ERC, preoperative ES, and LC. |
| |
Keywords: | |
本文献已被 PubMed SpringerLink 等数据库收录! |
|