Comparison of Laparoscopic Common Bile Duct Exploration and ERCP/S LC for Choledocholithiasis: A prospective randomized study

Bora Koc, MD, Servet Karahan, prof, Gokhan Tolga Adas, MD, Ayhan Ozsoy, MD, Furat Tutal, MD

Department of Surgery, Okmeydan Training and Research Hospital

Background: Choledocholithiasis develops in about 10-20% of patients with gallbladder stones and at least 3-10% of patients undergoing cholecystectomy will have common bile duct (CBD) stones. ERCP and laparoscopic common bile duct exploration (LCBDE) are safe and efficient methods that are recently used for the treatment of bile duct stones. In this study, our aim was to compare the efficacy, safety and the surgical outcomes of the laparoscopic common bile duct exploration plus laparoscopic cholecystectomy (LCBDE+LC) and endoscopic retrograde cholangiopancreatography plus laparoscopic cholecystectomy (ERCP+LC).

Material and Methods: 120 patients, who were admitted and treated with the diagnoses of gall bladder and common bile duct stones between January 2008 and September 2010 were included in the study. The patients were prospectively randomized in two groups, which were LCBDE with LC in a single intervention and LC after ERCP.

Results: In LCBDE+LC group, 64.9% of the patients were female and 35.1% were male; whereas in ERCP+LC group, 66.6% of the patients were female and 33.4% were male. Success rate of LCBDE+LC group (96.5%) has been found higher than ERCP+LC group (94.4%). Complication rates of LCBDE+LC group and ERCP+LC group were 7% and 11.1% ,respectively. Recurrent stones are noted in 3.5% of the cases in LCBDE group which is no different than other studies in literature. Complications requiring ERCP in postoperative period after LCBDE+LC (recurrent stones and/or bile leak) has been noted in 3.5% of the cases. Patients in this group have been in the follow-up term approximately for 18 months and no further complications are noted. There is no mortality in each groups.

Conclusion: Laparoscopic CBD exploration provides an alternative therapeutic approach which is less morbidity, efficacy and allows early recovery with a reduced period of short-term disability. LCBDE minimizes life-threatening complications and preserves the normal anatomic functions compared to ERCP+LC.

Session: Poster Presentation

Program Number: P342

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