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Endoscopic versus laparoscopic treatment for choledocholithiasis: a prospective randomized controlled trial
Javier Ernesto Barreras González1, Rafael Torres Peña1, Julián Ruiz Torres1
1Department of Laparoscopic and Endoscopic Surgery, National Center for Minimally Invasive Surgery, Havana Medical University, Havana, Cuba.
Endoscopy International Open
|November 19, 2016
Summary
Intraoperative ERCP/ES for bile duct stones offers better clearance and shorter hospital stays compared to other methods. Single-stage treatments appear most effective for selected patients.
Area of Science:
- Gastroenterology
- Surgical Innovation
- Biliary Tract Diseases
Background:
- Cholelithiasis often coexists with bile duct stones (choledocholithiasis), particularly in older patients.
- Optimal treatment strategies for choledocholithiasis remain debated, with no clear consensus on endoscopic versus surgical approaches.
Purpose of the Study:
- To prospectively compare three treatment options for patients diagnosed with choledocholithiasis.
- To evaluate the efficacy and safety of intraoperative cholangiography with laparoscopic cholecystectomy and intraoperative ERCP, preoperative ERCP followed by LC, and LC with laparoscopic common bile duct exploration.
Main Methods:
- A prospective randomized controlled trial involving 300 patients with suspected choledocholithiasis.
- Patients were randomized into three groups receiving different combinations of diagnostic and therapeutic interventions.
- Interventions included intraoperative cholangiography (IOC), laparoscopic cholecystectomy (LC), preoperative endoscopic retrograde cholangiopancreatography (ERCP), and laparoscopic common bile duct exploration (LCBDE).
Main Results:
- 134 patients were diagnosed with choledocholithiasis and treated.
- No significant differences were observed in the success rates of ductal stone clearance across the groups.
- Group I (IOC followed by LC with intraoperative ERCP) demonstrated better outcomes regarding retained stones, postoperative complications, and length of hospital stay.
Conclusions:
- Intraoperative ERCP/ES shows promise for higher common bile duct stone clearance rates, shorter hospital stays, and reduced morbidity.
- Further research with larger cohorts is needed to confirm the benefits of intraoperative ERCP/ES.
- Single-stage treatment approaches appear to be the most effective options for appropriate patients with choledocholithiasis.
