Biliary lithiasis: combined endoscopic and surgical treatment

Area of Science:

• Gastroenterology and Hepatobiliary Surgery
• Minimally Invasive Procedures

Background:

• Gallbladder lithiasis frequently coexists with common bile duct (CBD) stones.
• Accurate diagnosis and effective treatment of choledocholithiasis are crucial.

Purpose of the Study:

• To evaluate the efficacy and safety of a combined two-day endoscopic and surgical approach for gallbladder lithiasis with suspected CBD stones.
• To assess the diagnostic and therapeutic outcomes of this combined strategy.

Main Methods:

• A total of 69 patients underwent a two-day procedure: Day 1 involved Endoscopic Retrograde Cholangiopancreatography (ERCP) with potential endoscopic sphincterotomy and stone removal.
• Day 2 consisted of cholecystectomy, with intraoperative cholangiography.
• Patients with suspected common bile duct stones were included.

Main Results:

• ERCP identified choledocholithiasis in 50 patients and papillary sclerosis in 4; 15 had normal CBDs.
• Endoscopic stone removal was complete in 44 of 50 choledocholithiasis cases.
• The combined procedure resulted in an average hospitalization of 12.4 days, with 7.2% morbidity and 1.4% mortality (unrelated to technique).

Conclusions:

• The combined endoscopic and surgical approach is effective for managing gallbladder lithiasis with associated common bile duct stones.
• This strategy demonstrates a low rate of residual choledocholithiasis and acceptable morbidity and mortality.
• The diagnostic and therapeutic significance of this staged procedure warrants consideration in clinical practice.