Single-stage laparoscopic operations for choledocholithiasis

Introduction. Aim of study was to compare the long-term results of laparoscopic (one-stage procedures) and endoscopic (two-stage procedures) methods of common bile duct (CBD) exploration.
Methods and procedures. Among 5307 patients who underwent laparoscopic cholecystectomy from 1992 till 2006, 580 patients had choledocholithiasis. There were 215 males and 365 females with mean age of 60,9 ± 7,6 years. Patients with CBD stones were divided into 2 groups. The I group consisted of 252 patients who underwent two-stage procedures: endoscopic retrograde cholangio-pancreatography and endoscopic sphincterotomy (ERCP/ES) and then laparoscopic cholecystectomy. The II group consisted of 328 patients, who underwent single-stage procedures (laparoscopic cholecystectomy). In this group, ERCP/ES was used postoperatively only in 38 cases (11,6 %).
Results: There was no mortality in both groups. Morbidity was 15,9 % in the I group and 7,7 % in the II group. Mean hospital stay was 11,8 ± 4,3 days in the I group and 6,5 ± 2,4 days in the II group. Average surgery time was 96,2 ± 27,8 min in the I group and 119,5 ± 32,3 min in the II group. The analysis of questionnaires obtained from 478 (82,4 %) patients at 12 – 60 months after operation revealed better long-term results in the II group. Clinical signs of moderate cholangitis were observed in 20 % of patients from I group. Thus, the post-procedures quality of life in the II group was significantly higher due to minimal damage to sphincter of Oddi.
Conclusions: Single-stage laparoscopic biliary surgery provides better results and shorter hospital stay than two-stage procedures. Damage to sphincter Oddi should be minimal to avoid the reflux-cholangitis.

Session: Poster

Program Number: P324

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