Management of choledocholithiasis: comparison between laparoscopic common bile duct exploration and intraoperative...

Choledocholithiasis is present in 5 to 10 percent of patients who have cholelithiasis. In the area of laparoscopic cholecystectomy (LC), laparoscopic common bile duct exploration (LCBDE) and intraoperative endoscopic sphincterotomy (IOES) have been used to treat choledocholithiasis. The purpose of this study was to compare the clinical outcomes and hospital costs of LCBDE with IOES.

Between November 1999 and October 2002, patients with choledocholithiasis undergoing LC plus LCBDE (Group A, n=45) were retrospectively compared to those undergoing LC plus IOES (Group B, n=57) at a single institution.

Ductal stone clearance rates were equivalent for the two groups (88% versus 89%, P=0.436). The conversion rate was higher for Group B (8.8% versus 4.4%, P=0.381), as was the morbidity (12.3% versus 6.7%, P=0.336). There were no other significant differences between the two groups. The complications were mainly related to endoscopic sphincterotomy (ES), and the hospital costs were significantly increased in this subset of Group B (median, 23,910 versus 14,955 RMB yuan, P=0.03). Although hospital stay was longer in Group A (median, 7 versus 6 days, P=0.041), the patients in Group A had a significantly decreased cost of hospitalization compared with those in Group B (median, 11,362 versus 15,466 RMB yuan, P=0.000).

The results demonstrate equivalent ductal stone clearance rates for the two groups. LCBDE management appears safer, and is associated with a significantly decreased hospital cost. The findings suggest LCBDE for choledocholithiasis is a better option.