Laparoscopic Exploration versus Intraoperative Endoscopic Sphincterotomy for Common Bile Duct Stones: A Prospective Randomized Trial

Abstract

Background/Aims: Laparoscopic cholecystectomy (LC) combined with intraoperative endoscopic sphincterotomy (IOES) was compared to LC with laparoscopic common bile duct exploration (LCBDE) to define the best single-session minimally invasive treatment for cholecystocholedocholithiasis. Methods: Between June 2009 and December 2010, patients with gallstones and common bile duct (CBD) stones diagnosed by preoperative ultrasonography and magnetic resonance cholangiopancreatography were randomized to LC-LCBDE or LC-IOES. The primary end point was complete clearance of CBD of stones. The secondary end points were operation time, conversion rate, length of hospital stay, complications and mortality. Results: Two hundred and twenty-six patients were eligible. They were randomized to LC-LCBDE (n = 115) and LC-IOES (n = 111). There was no statistically significant difference in the success rate of CBD clearance between the two interventions (92% for LC-LCBDE vs. 97.2% for LC-IOES with a p value >0.05). There were no differences between the two groups in terms of surgical time and postoperative length of stay. Pancreatitis and bleeding sphincterotomy were significantly more prevalent in the LC-IOES group, while bile leakage and retained CBD stones were significantly more prevalent in the LC-LCBDE group. Conclusion: Both LC-IOES and LC-LCBDE were shown to be safe, effective, minimally invasive treatments for cholecystocholedocholithiasis, but the former option may be preferred when facilities and experience in endoscopic therapy exist.

Primary Closure and Rate of Bile Leak following Laparoscopic Common Bile Duct Exploration via Choledochotomy

“…Lauter and Froines [8] reported that 11 of 71 patients (15.5%) had retained stones after LCBDE. A more recent study reported that 4 of 115 patients (3.4%) had retained stones following LCBDE [22]. However, in our series, the rate of retained stones was 1.9% (3 of 157 patients), which was much lower than in previously published series.…”

Randomized clinical trial of intraoperative endoscopic retrograde cholangiopancreatography versus laparoscopic bile duct exploration in patients with choledocholithiasis

“…Hong and colleagues randomized 234 patients with choledocholithiasis diagnosed by preoperative ultrasonography or IOC and found similar duct clearance rates for both groups: 89 per cent for the 141 patients having LBDE and 91 per cent for the 93 undergoing intraoperative endoscopic sphincterotomy. ElGeidie et al . randomized 226 patients with choledocholithiasis on IOC and similarly found no significant difference in duct clearance between the groups: 92 per cent in 112 patients in the LBDE group versus 97 per cent in 107 undergoing intraoperative endoscopic sphincterotomy.…”

“…Only two previous studies have compared LBDE with intraoperative ERCP. Hong and colleagues randomized 234 patients with choledocholithiasis diagnosed by preoperative ultrasonography or IOC and found similar duct clearance rates for both groups: 89 per cent for the 141 patients having LBDE and 91 per cent for the 93 undergoing intraoperative endoscopic sphincterotomy.…”

Therapeutic experience of 289 elderly patients with biliary diseases

“…The oldest patients were a 96-year-old reported by Lee et al[10] and a 102-year-old reported in China[45]. In our study, 112 patients underwent LC (including 7 patients who underwent LC + EST/EPBD)[46,47], with a success rate of 100%, and none of the patients were converted to laparotomy. The key to success is management of indications and the opportunity to perform LC.…”