Total laparoscopic versus endolaparoscopic common bile duct stone extraction and cholecystectomy

Abstract

Background Endoscopic retrograde cholangiopancreatography followed by laparoscopic cholecystectomy (LC) was the traditional method for the treatment of common bile duct (CBD) stones associated with gall bladder (GB) stones. With advances in laparoscopic instrumentation and skills, totally laparoscopic transcystic common bile duct exploration is technically feasible and increasingly practiced by surgeons worldwide. Objective The aim of this study was to compare the results of the two procedures in the management of CBD stones associated with GB stones. Patients and methods A prospective randomized clinical study was carried out from December 2010 to December 2015. It included 252 patients with concomitant GB stones and CBD stones who were divided into two groups: group A (126 patients) included patients who underwent laparoscopic transcystic common bile duct exploration and stone extraction with LC in one stage, and group B (126 patients) included patients who underwent endoscopic retrograde cholangiopancreatography for CBD stone extraction followed by LC after 2–3 days in two stages. Patients were followed up postoperatively at 1 week, 1, 6 months, and 1 year. Results The success rate was similar in groups A and B (88.1% in group A vs. 80.2% in group B; P = 0.2). The average number of procedures per patient was significantly lower in group A ( P P P = 0.6). On the first day after surgery, the pain score was lower in group A ( P = 0.03). Hospital stay of group A patients was significantly shorter ( P = 0.03). The cost of treatment per patient in group A was significantly lower ( P = 0.001). The patients in group A had higher satisfaction scores ( P = 0.006). Conclusion Although both approaches have equivalent success rates, the one-stage approach is better in terms of shorter hospital stay, fewer procedures, and better satisfaction and cost-effectiveness compared with the two-stage approach. Our study suggests that one-stage management is the treatment of choice for patients with concomitant GB and CBD stones.