A Prospective Randomized Trial Comparing Single Stage Versus Two Stage Management of Patients with Gall Stones and Cbd Stones

The optimal management of patients with concomitant gall stones and CBD calculi is controversial. The options for management include either a single stage approach of laparoscopic cholecystectomy along with laparoscopic common bile duct exploration or a two stage approach which includes preoperative endoscopic stone extraction followed by laparoscopic cholecystectomy. This prospective randomized trial was done to compare the outcome of patients undergoing treatment with these two approaches.

The study was carried out between January 2007 and April 2008. 30 patients with gall stones and CBD stones were randomized to either of the two treatment options: Group I i.e. single stage laparoscopic cholecystectomy and laparoscopic CBD exploration (LC + LCBDE) or Group II i.e. two stage endoscopic stone extraction followed by laparoscopic cholecystectomy (ESE- LC). The diagnosis of CBD stones was confirmed preoperatively in all patients with either MRCP (magnetic resonance cholangiopancreatography) or EUS (endoscopic ultrasound). Outcome measures like success of the intended approach, complications and patient satisfaction scores were recorded.

15 patients were randomized to each group. The demographic and clinical profiles were well matched in both the groups. MRCP and EUS had 100% sensitivity and positive predictive value for diagnosis of CBD stones.
Success rate with the intended treatment option was 93.5% (14 out of 15 patients) in Group I as compared to 73.3% in Group II (2 failures of ESE and 2 conversions for laparoscopic cholecystectomy). Group I was found to have a 20% higher success rate as compared to Group II (RR 1.27), which did not attain any statistical significance because of small sample size.
There was no statistically significant difference in hospital stay, intra-operative complications, conversions, post operative wound infection rates or major complications. Patients in Group 1 showed a better overall satisfaction score as compared to Group 2.

Single stage laparoscopic management of patients with gall stones and CBD stones is favorable because of lesser number of procedures and hospital visits, with no major difference in outcome.

Session: Poster of Distinction

Program Number: P011

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