Sequential intraluminal endoscopic and laparoscopic treatment for bile duct stones associated with gallstones

Zaninotto, Giovanni; Costantini, Mauro; Rossi, Michael; Anselmino, Marco; Pianalto, S.; Oselladore, D.; Pizzato, D.; Norberto, L.; Ancona, E.

doi:10.1007/s004649900119

Cited by 3 publications

(6 citation statements)

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“…If ES is performed preoperatively, a two-stage treatment is necessary since it is followed by LC (sequential treatment) and thus accumulates the risks of the two techniques, the morbidity being of the order of 7% on average in the literature [2,5,11,12,20]. Moreover, the rate of detection of CBDS during retrograde endoscopic cholangiography is relatively low, since it varies between 50% and 60% [2, 11-13, 16, 20].…”

Section: Discussionmentioning

confidence: 99%

Management of common bile duct stones in a single operation combining laparoscopic cholecystectomy and perioperative endoscopic sphincterotomy

Meyer

Rohr

et al. 1999

Surg Endosc

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Section: Discussionmentioning

confidence: 99%

Management of common bile duct stones in a single operation combining laparoscopic cholecystectomy and perioperative endoscopic sphincterotomy

Meyer

Rohr

et al. 1999

Surg Endosc

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“…However, controversy still remains regarding the management of CBDS between those in favor of laparoscopy alone [3, 4, 11]and those in favor of ES combined with LC [5, 12, 13, 14, 15, 16]. …”

Section: Discussionmentioning

confidence: 99%

“…Treatment in two stages, which combines a preoperative ES followed by LC (sequential treatment), accumulates the morbidity of the two techniques and also has a relatively low detection rate of CBDS, in the range of 50–60%, during ERC [5, 14, 16, 19, 20]. Postoperative ES performed after LC has the advantages of maintaining minimally invasive treatment and of avoiding an unnecessary ERC.…”

Section: Discussionmentioning

confidence: 99%

Management of Common Bile Duct Stones by Laparoscopic Cholecystectomy and Endoscopic Sphincterotomy: Pre-, Per- or Postoperative Sphincterotomy?

Meyer¹,

Le²,

Rohr³

et al. 1999

Dig Surg

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Background/Aims: The aim of this study was to evaluate the treatment of common bile duct stones (CBDS) by endoscopic sphincterotomy (ES) and laparoscopic cholecystectomy (LC), ES being performed either pre-, per- or postoperatively. Methods: Between January 1990 and June 1997, 386 patients with a median age of 60 (range 18–92) years were treated for suspected or confirmed CBDS. The CBDS were uncomplicated in 264 cases (70%) but associated with a complication in 122 cases (30%), namely, cholangitis (69 cases) or acute pancreatitis (53 cases). ES combined with LC was carried out in 233 cases (60%): ES was preoperative (sequential treatment in two stages) in 197 cases (51%); peroperative in 30 cases (7%), or postoperative in 6 cases (2%). Laparoscopic extraction was performed in 58 cases (15%) and conventional surgery in 82 cases (21%). Results: With respect to sequential treatment, endoscopic retrograde cholangiography showed the presence of CBDS in 117 cases (60%) and preoperative ES allowed the release of the CBDS in 82% of these cases. The complication rate of sequential treatment was 8% (15 cases) after ES and 7% (13 cases) after LC, with 1 death (0.5%). A peroperative ES performed after LC enabled evacuation of the CBDS in 28 cases (93%) without any complications or mortality. Postoperative ES was successful in 100% of cases with residual lithiasis in 16% (1 case) and a complication rate of 16% (1 case). Conclusion: Along with conventional surgery and laparoscopic extraction, ES combined with LC represents an effective alternative in the management of CBDS. Since it can be performed peroperatively, it allows a one-stage, minimally invasive treatment of most uncomplicated CBDS.

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“…The diagnosis and treatment strategy to apply to CBDS is always a controversial subject. While traditional surgery remains the reference treatment, with well codified technique and good established results for more than 20 years, the current tendency is mainly towards minimally invasive methods with an exclusively laparoscopic approach to stone extraction, or the multidisciplinary option called “sequential treatment”, with ES combined with LC . The results of the two techniques, recently published in a multicenter randomized study, are superimposable, with 90% stone clearance, mortality almost zero, and morbidity less than 10% 12…”

Section: Discussionmentioning

confidence: 99%

“…Concerning the sequential treatment, ES was first proposed preoperationally, followed by LC. This imposes on the patient a two‐stage treatment and accumulates the risks of the two techniques,7,8, with a longer hospital stay, because, on average, LC is not performed until 2 or 3 days after the endoscopic procedure. Moreover, the rate of detection of CBDS during endoscopic retrograde cholangiography (ERC) is relatively low, varying between 50% and 60% 7,8,10,11,13,14…”

Section: Discussionmentioning

confidence: 99%

Management of common bile duct stones in a single operation combining laparoscopic cholecystectomy and peroperative endoscopic sphincterotomy

Meyer

Rohr

et al. 2002

Journal of Hepato-Biliary-Pancreatic Surgery

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The diagnosis and treatment strategy to apply to common bile duct stones (CBDS) is always a controversial subject. The aim of this study was to evaluate the treatment of CBDS in a "one-stage" operation by laparoscopic cholecystectomy (LC) and peroperative endoscopic sphincterotomy (ES). Between January 1994 and April 2000, 60 patients, 24 men and 36 women (sex ratio, 1.5), with a median age of 57 years (range, 26 to 84 years), were treated for suspected or confirmed CBDS. The CBDS were uncomplicated in 53 patients (88%) and associated with a complication in 7 patients (12%); namely, cholangitis (in 3 patients) and acute pancreatitis (in 4 patients). The peroperative ES was performed immediately after the LC during the same operative time, with peroperative cholangiography being systematically performed. The mean operative time for LC was 60 min (range, 40-90 min). The general anesthesia was prolonged by 40 min in order to perform an ES (range, 30-60 min), including the time required for endoscopic equipment installation. The peroperative ES was unsuccessful in 2 patients (3%) due to the impossibility of catheterizing the papilla. In the first patient, postoperative ES was successful. In the second patient, the small CBDS was left to pass spontaneously. In 1 patient, because of multiple calculi in the CBD, open surgery was performed immediately after the ES. In 2 patients, a residual stone was found by cholangiography on the sixth postoperative day, and spontaneous evacuation occurred 2 weeks later. Final ductal clearance was achieved in 100% of the patients. There was no mortality and the incidence of postoperative minor complications was 3% (2 patients). The duration of postoperative hospitalization was 4.6 days (range, 3-11 days). The one-stage treatment procedure is, to us, an alternative to the minimally invasive treatment of CBDS. This method is rapid, reliable, and safe. It now needs to be evaluated in larger studies, keeping in mind that the limiting characteristic is the proximity and the availability of the endoscopic team.

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Sequential intraluminal endoscopic and laparoscopic treatment for bile duct stones associated with gallstones

Abstract: In conclusion, BD stones can be endoscopically cleared preoperatively in most patients without interfering with LC.

Cited by 3 publications

References 0 publications

Management of common bile duct stones in a single operation combining laparoscopic cholecystectomy and perioperative endoscopic sphincterotomy

Management of common bile duct stones in a single operation combining laparoscopic cholecystectomy and perioperative endoscopic sphincterotomy

Management of Common Bile Duct Stones by Laparoscopic Cholecystectomy and Endoscopic Sphincterotomy: Pre-, Per- or Postoperative Sphincterotomy?

Management of common bile duct stones in a single operation combining laparoscopic cholecystectomy and peroperative endoscopic sphincterotomy

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