Choledocholithiasis: endotherapy versus surgery

When multiple treatment options are available, debate invariably persists regarding the optimal option. Confusion and controversy must then be resolved based on scientific evidence, but one needs to be practical because options depend on the available expertise. We aimed to evaluate the efficacy of endotherapy vis-à-vis surgery in patients with choledocholithiasis. The records of 349 patients with stone disease from February 2005 to January 2010 were analyzed. A total of 349 patients were analyzed: 279 patients with gallstones alone, 56 with choledocholithiasis, 3 with stones with stricture, 5 with common bile duct (CBD) and pancreatic duct (PD) stones, and 6 with combined choledocholithiasis and hepatolithiasis. In the 56 patients with choledocholithiasis alone, preoperative endoscopic retrograde cholangio pancreatography (ERCP) and endotherapy were followed by cholecystectomy within 48 hours. Endotherapy was successful in 15 patients, whereas surgery was required in the remaining 41 patients. Surgery is an efficacious option and can be carried out safely with acceptable morbidity and no mortality, even in difficult situations.