Comparative study between laparoscopic common bile duct exploration and endoscopic retrograde cholangiopancreatography plus laparoscopic cholecystectomy for choledocholithiasis

Authors

  • Mohamed Mohsen Salem General Surgery Department, Al-Azhar University, Cairo, Egypt
  • Mohamed Emad Esmat General Surgery Department, Theodor Bilhariz Research Institute, Giza, Egypt
  • Ahmed Mohamed Abdelaziz Hassan General Surgery Department, Theodor Bilhariz Research Institute, Giza, Egypt
  • Yaser Amer General Surgery Department, Al-Azhar University, Cairo, Egypt
  • Hisham Abdelaziz General Surgery Department, Theodor Bilhariz Research Institute, Giza, Egypt
  • Mahmoud Rady General Surgery Department, Theodor Bilhariz Research Institute, Giza, Egypt

DOI:

https://doi.org/10.18203/2349-2902.isj20192943

Keywords:

Bile duct stones, Endoscopic retrograde cholangiopancreatography, Laparoscopic common bile duct exploration, Laparoscopic cholecystectomy

Abstract

Background: Endoscopic retrograde cholangiopancreatography (ERCP) with consequent laparoscopic cholecystectomy (LC) has been the favored approach for the treatment of choledocholithiasis for a long time; however recently, laparoscopic common bile duct exploration (LCBDE) has been offered to patients with suspected choledocholithiasis. Objective and aim of this work was to compare the efficacy, safety, and the surgical outcomes of LCBDE with ERCP followed by LC and determine the most appropriate approach for patients with choledocholithiasis.

Methods: A prospective clinical study was carried out from March 2017 to September 2018. It included 50 patients with cholecysto-choledocholithiasis who were divided into two groups: group A (25 patients) included patients who underwent transcystic LCBDE and stone extraction with LC in one stage, and group B (25 patients) included patients who underwent ERCP followed by LC in two stages. The common bile duct (CBD) stone clearance rate, postoperative bile leakage, postoperative morbidity, mortality, overall hospital stay, and patient satisfaction were analyzed.

Results: LCBDE and ERCP+LC were similar in terms of clearance rate, operative time, postoperative complications, retained CBD stones, and postoperative length of stay, but there was a significant difference in number of procedures and patient satisfaction.

Conclusions: Although both approaches have equivalent success rates, LCBDE is better in terms of fewer procedures, and better satisfaction compared with ERCP + LC. Our study suggests that one-stage management is the treatment of choice for patients with cholecysto-choledocholithiasis.

References

Pham TH, John G. Hunter Gallbladder and the Extrahepatic Biliary. In: Schwartz's Principles of Surgery, part II, Specific Considerations, Chapter 33, 10th edition. Charles FB, Dana KA, Timothy RB, et al, editors. McGraw-Hill Companies, Inc; 2015: 1310-40.

Mori T, Suzuki Y, Sugiyama M, Atomi Y. Choledocholithiasis. In: Bland KI, Büchler MW, Csendes A, et al, editors General Surgery. Principles and International Practice. Second Edition. London: Springer-Verlag London; 2009: 1061-1073.

Rábago LR, Chico I, Collado D, Olivares A, Ortega A, Quintanilla E, et al. Single-stage treatment with intraoperative ERCP: management of patients with possible choledocholithiasis and gallbladder in situ in a non-tertiary Spanish hospital. Surg Endosc. 2012;26:1028-34.

Ghazal AH, Sorour MA, El-Riwini M, El-Bahrawy H. Single-step treatment of gallbladder and bile duct stones: A combined endoscopic–laparoscopic technique. Int J Surg. 2009;7:338-46.

Chathadi KV, Chandrasekhara V, Acosta RD, Decker GA, Early DS, Eloubeidi MA, et al. ASGE Standards of Practice Committee, The role of ERCP in benign diseases of the biliary tract. Gastrointest Endosc. 2015;81(4):795-803.

Easler JJ, Sherman S. Endoscopic Retrograde Cholangio-pancreatography for the Management of Common Bile Duct Stones and Gallstone Pancreatitis. Gastrointest Endosc Clin N Am. 2015;25(4):657-75.

Darkahi B, Liljeholm H, Sandblom G. Laparoscopic Common Bile Duct Exploration: 9 Years Experience from a Single Center. Front Surg. 2016;3:23.

Aawsaj Y, Light D, Horgan L. Laparoscopic common bile duct exploration: 15-year experience in a district general hospital. Surg Endosc. 2016;30(6):2563-6.

Ha JP, Tang CN, Siu WT, Chau CH, Li MK. Primary closure versus T-tube drainage after laparoscopic choledochotomy for common bile duct stones. Hepatogastroenterol. 2004;51(60):1605-8.

Gupta N. Role of laparoscopic common bile duct exploration in the management of choledocholithiasis. World J Gastrointest Surg. 2016;8(5):376-81.

Qiu J, Yuan H, Chen S, Wu H. Laparoscopic common bile duct exploration in cirrhotic patients with choledocholithiasis. Surg Laparosc Endosc Percutan Tech. 2015;25(1):64-8.

Hungness ES, Soper NJ. Management of common bile duct stones. J Gastrointest Surg. 2006;10(4):612-9.

Vindal A, Chander J, Lal P, Mahendra B. Comparison between intraoperative cholangiography and choledochoscopy for ductal clearance in laparoscopic CBD exploration: a prospective randomized study. Surg Endosc. 2015;29:1030-8.

Zerey M, Haggerty S, Richardson W, Santos B, Fanelli R, Brunt LM, et al. Laparoscopic common bile duct exploration. Surg Endosc. 2018;32:2603.

Dolan JP, Diggs BS, Sheppard BC, Hunter JG. The National Mortality Burden and Significant Factors Associated with Open and Laparoscopic Cholecystectomy: 1997-2006. J Gastrointest Surg. 2009;13(12):2292-301.

Bansal VK, Misra MC, Rajan K, Kilambi R, Kumar S, Krishna A, et al. Single stage laparoscopic common bile duct exploration and cholecystectomy versus two-stage endoscopic stone extraction followed by laparoscopic cholecystectomy for patients with concomitant gallbladder stones and common bile duct stones: a randomized controlled trial. Surg Endosc. 2014;28:875-85.

Kharbutli, Velanovich V. Management of preoperatively suspected choledocholithiasis: a decision analysis, J Gastrointest Surg, 2008;12(11):1973-80.

Hong DF, Xin Y, Chen DW. Comparison of laparoscopic cholecystectomy combined with intraoperative endoscopic sphincterotomy and laparoscopic exploration of the common bile duct for cholecystocholedocholithiasis. Surg Endosc. 2006;20(3):424-7.

Griniatsos J, Karvounis E, Isla AM. Limitations of fluoroscopic intraoperative cholangiography in cases suggestive of choledocholithiasis, J Laparoendoscopic Advanced Surg Tech. 2005;15(3):312-7.

Mattila A, Luhtala J, Mrena J, Kautiainen H, Kellokumpu I. An audit of shortand long-term outcomes after laparoscopic removal of common bile duct stones in Finland. Surg Endosc. 2014;28:3451-7.

Chan DS, Jain PA, Khalifa A, Hughes R, Baker AL. Laparoscopic common bile duct exploration. Br J Surg. 2014;101:1448-52.

Zhang HW, Chen YJ, Wu CH, Li WD. Laparoscopic common bile duct exploration with primary closure for management of choledocholithiasis: a retrospective analysis and comparison with conventional T-tube drainage. Am Surg. 2014;80:178-81.

Zhu HY, Xu M, Shen HJ, Yang C, Li F, Li KW, Shi WJ, Ji F. A meta-analysis of single-stage versus two-stage management for concomitant gallstones and common bile duct stones. Clin Res Hepatol Gastroenterol. 2015;39(5):584–593.

Dasari BV, Tan CJ, Gurusamy KS, Martin DJ, Kirk G, McKie L, et al. Surgical versus endoscopic treatment of bile duct stones. Cochrane Database Syst Rev. 2013;12:Cd003327.

Pan L, Chen M, Ji L, Zheng L, Yan P, Fang J, et al. The safety and efficacy of laparoscopic common bile duct exploration combined with cholecystectomy for the management of cholecysto-choledocholithiasis: an up-to-date meta-analysis. Ann Surg. 2018;268(2):247-53.

ElGeidie A, Atif E, Naeem Y, ElEbidy G. Laparoscopic bile duct clearance without choledochoscopy. Surg Laparosc Endosc Percutan Tech. 2015;25(5):152-5.

Rogers SJ, Cello JP, Horn JK. Prospective Randomized Trial of LC_LCBDE vs ERCP/S_LC for Common Bile Duct Stone Disease. Archsurg. 2010;145:28-33.

Ding YM, Wang B, Wang WX, Wang P, Yan JS. New classification of the anatomic variations of cystic artery during laparoscopic cholecystectomy. World J Gastroenterol. 2007;13:5629-34.

Lee J, Yoon Y. Laparoscopic common bile duct exploration using V-Loc suture with insertion of endobiliary stent. Surg Endosc. 2016;30(6):2530-4.

Phillips EH, Toouli J, Pitt HA, Soper NJ. Treatment of common bile duct stones discovered during cholecystectomy. J Gastrointest Surg. 2008;12:624-8.

Topal B, Aerts R, Penninckx F. Laparoscopic common bile duct stone clearance with flexible choledochoscopy, Surg Endosc. 2007;21;2317-21.

Lyu Y, Cheng Y, Li T, Cheng B, Jin X. Laparoscopic common bile duct exploration plus cholecystectomy versus endoscopic retrograde cholangiopancreatography plus laparoscopic cholecystectomy for cholecystocholedocholithiasis: a meta-analysis. Surg Endosc. 2018.

Vitale GC, Zavaleta CM, Vitale DS, Binford JC, Tran TC and Larson GM. Training surgeons in endoscopic retrograde cholangiopancreatography. Surg Endosc. 2006;20(1):149-52.

Allen NL, Leeth RR, Finan KR, Tishler DS, Vickers SM, Wilcox CM, et al. Outcomes of cholecystectomy after endoscopic sphincterotomy for choledocholithiasis. J Gastrointest Surg. 2006;10:292-6.

Donkervoort SC, van Ruler O, Dijksman LM, van Geloven AA, Pierik EG. Identification of risk factors for an unfavorable laparoscopic cholecystectomy course after endoscopic retrograde cholangiography in the treatment of choledocholithiasis. Surg Endosc. 2010;24;798-804.

Noble H, Tranter S, Chesworth T, Norton S, Thompson MA. Randomized, clinical trial to compare endoscopic sphincterotomy and subsequent laparoscopic cholecystectomy with primary laparoscopic bile duct exploration during cholecystectomy in higher risk patients with choledocholithiasis. J Laparoendosc Adv Surg Tech A. 2009;19;713-20.

Martin DJ, Vernon DR. and Toouli J. Surgical versus endoscopic treatment of bile duct stones. Cochrane Database Syst Rev. 2006;2:CD003327.

Lu J, Cheng Y, Xiong XZ, Lin YX, Wu SJ, Cheng NS. Two-stage vs singlestage management for concomitant gallstones and common bile duct stones. World J Gastroenterol. 2012;18:3156-66.

Shojaiefard A, Esmaeilzadeh M, Ghafouri A, Mehrabi A. Various Techniques for the Surgical Treatment of Common Bile Duct Stones: A Meta Review. Gastroenterol Res Pract. 2009;840208:12.

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Published

2019-06-29

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Original Research Articles