Laparoscopic common bile duct exploration versus intraoperative sphincterotomy for Management of Common Bile Duct Stones: A Prospective Randomized Trial

Ahmed A Elgeidie, Mohamed M Elshobary, Yussef E Naeem, Mohamed M Elhemaly, Gamal K Elebeidy

gastroenterology surgical center, mansoura university

Background: Laparoscopic cholecystectomy (LC) combined with intraoperative endoscopic sphincterotomy (IOES) was prospectively and randomly compared with laparoscopic common bile duct exploration (LCBDE) in an attempt to find the best single-session minimally invasive treatment for cholecystocholedocholithiasis.

Methods: Between March 2008 and April 2012, patients with gallstones (GS) and common bile duct (CBD) stones diagnosed by preoperative ultrasonography and magnetic resonance cholangiopancreatography (MRCP) were divided at random into LCBDE group and LC-IOES group. The surgical success rates, surgical times, postoperative complications, retained common bile duct stones, and postoperative lengths of stay were compared prospectively.

Results: Out of 365 patients with suspected CBD stones 274 patients fulfilled the inclusion criteria and were analyzed. They were randomized into LCBDE (n=138) and LC-IOES (n=136). There were no differences between the two groups in terms of surgical time, surgical success rate, and postoperative length of stay. Pancreatitis and bleeding sphincterotomy were significantly more in LC-IOES group, while bile leakage and retained CBD stones were significantly more in 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 for endoscopic therapy do exist.


Session: Podium Presentation

Program Number: S099

« Return to SAGES 2013 abstract archive