[Changes in the treatment of choledocholithiasis]

Area of Science:

• Gastroenterology and Surgical Innovation
• Minimally Invasive Procedures in Biliary Tract Surgery

Background:

• Therapeutic strategies for gallstone and bile duct stones have evolved with advancements in endoscopic and laparoscopic techniques.
• A retrospective study was conducted to compare outcomes before and after the widespread adoption of laparoscopic cholecystectomy (LC).

Purpose of the Study:

• To evaluate the effectiveness and safety of modern endoscopic and laparoscopic approaches for treating common bile duct stones (CBDS).
• To compare postoperative complications, perioperative mortality, and hospital stay between a recent treatment era and a pre-laparoscopic era.

Main Methods:

• Retrospective analysis of 734 patients treated between 1993-1998 (endoscopic sphincterotomy (EST) followed by LC or open choledochotomy) compared to 534 patients from 1986-1991 (EST and open choledochotomy).
• Statistical evaluation of complication rates, mortality, and mean hospital stay.

Main Results:

• The recent group (1993-1998) had significantly lower complication rates (4.4% vs. 10.6%) and a shorter mean hospital stay (6.5 days vs. 13.4 days) compared to the control group (1986-1991).
• Mortality rates showed a decrease (0.9% vs. 1.9%) but not statistically significant.
• Significant cost savings per patient were observed with the modern approach.

Conclusions:

• The sequential endoscopic-laparoscopic approach offers a safer and more effective treatment for cholecysto-choledocholithiasis compared to previous methods.
• The adoption of minimally invasive techniques has led to improved patient outcomes and reduced healthcare costs.