The Optimal Choice to 1 Stage Procedure for the Treatment of Cholecysto-choledocholithiasis

Abstract

Introduction: The one-stage procedure for the treatment of cholecysto-choledocolithiasis turns out to be optimal in terms of reduction of costs and patient's compliance. We utilized trans-cystic clearance and intra-operative papillotomy through rendez-vous technique. There still lacks a procedure conform to every case, hence it would be appropriate to know preliminarily the best procedure for each specific patient. The goal of this study was to evaluate the reliability of pre-operative parameters to address the most suitable surgical procedure. Methods: From January 2008 to December 2015, we observed 1818 patients affected by gallbladder stones; among these, 186 (10.5%) were also affected by calculi of the bile duct. 180 consecutive patients underwent the single stage treatment. The group was composed of 102 women and 78 men and the average age was 53 years old (32-77). Patients were divided into two different groups according to the degree of the jaundice (< or >2gr/dL), the bile duct's diameter(< or >1,2 cm) and the calculi's diameter (< or >1 cm). Later, the patients were directed to the trans-cystic clearance procedure (Group A, 141 patients) or to the rendezvous procedure (Group B, 39 patients). We prospectively analyzed each group based on sex, age, surgical time, conversion rate, success rate of proposed treatment, post-operative complications and hospital stay. Results: Trans-cystic clean-up for group A patients was successful in 134 patients (90%), 2 patients needed to undergo a laparo-endoscopy (failure) and 5 patients underwent laparotomy with a conversion rate of 3.2%. 35 patients (89%) of group B obtained VBP clean-up through rendezvous, 1 patient obtained clean-up through simple trans-cystic procedure (failure), while for 3 patients (9.1%) it was necessary to convert the surgery. Post-operative complications showed similar percentages for both groups. However, the surgical time turned out to be longer for the rendez-vous group (207.3±88.5 m vs 124±52.7 m) with a statistically significant difference(. p value = 0.0001). Conclusion: The one-stage procedure for the treatment of cholecysto-choledocolithiasis was possible in 90% of the cases utilizing a surgical technique selected according to the patient's case history.