Objective: to compare outcome of two single-stage approaches: laparoscopic cholecystectomy plus laparoscopic exploration on common bile duct versus laparoscopic cholecystectomy plus intraoperative endoscopic retrograde cholangiopancreatography (ERCP) in patients with concomitant gall bladder stone with common bile duct stones.
Background: With refinements in technique and expertise in field of minimal access surgery; Single-stage approaches may shorten length of hospital stay and can be more efficacious for confirming common bile duct (CBD) stone clearance.
Patients and methods: This study included a total of 60 patients with a clinical diagnosis of choledocholithiasis. Thirty patients were operated upon by laparoscopic cholecystectomy with intraoperative ERCP while the other thirty patients were managed by laparoscopic cholecystectomy with laparoscopic common bile duct exploration. Follow-up period was 6 months.
Results: Mean duration of cholecystectomy was significantly higher in group A (0.74 h) compared to group B (0.55 h). P value was 0.007. Intraperitoneal collection was significantly higher in group B (30.0%) compared to group A (0.0%). P value was 0.002. There were no significant differences between both groups as regard pancreatitis (P value = 0.112), perforation (P value = 1.0), missed
stone (P value = 1.0) and recurrence of stone (p value = 0.254). No bleeding was reported in both groups.
Conclusion: the two reported procedures can be used for treating cholelithiasis with CBD stones. However, we recommend the use of intraoperative ERCP as a preferred option for management of patients with gallbladder stones and preoperatively diagnosed CBD stones when facilities for endoscopic therapy are readily available.
Keywords: CBD, Intraoperative ERCP, Laparoscopic CBD exploration, Outcomes. |
