Peroperative endoscopic sphincterotomy during laparoscopic cholecystectomy for choledocholithiasis

Area of Science:

• Gastroenterology
• Minimally Invasive Surgery
• Hepatobiliary Surgery

Background:

• Laparoscopic cholecystectomy presents management challenges for choledocholithiasis.
• Current treatment options for common bile duct (CBD) stones lack universal acceptance.
• Peroperative endoscopic sphincterotomy (ES) has emerged as an alternative approach.

Purpose of the Study:

• To prospectively assess the safety and efficacy of peroperative ES in patients undergoing laparoscopic cholecystectomy for choledocholithiasis.
• To evaluate the outcomes of peroperative ES in clearing CBD stones.

Main Methods:

• Prospective assessment of 13 patients with choledocholithiasis confirmed by operative cholangiography.
• Peroperative ES performed concurrently with laparoscopic cholecystectomy.
• Evaluation of stone clearance, operative time, hospital stay, and complications.

Main Results:

• Successful ES and CBD stone clearance in 11 out of 13 patients.
• Two cases required conversion to open common bile duct exploration.
• Mild complications included postoperative pancreatitis (2 patients) and pulmonary atelectasis (1 patient).
• Median operating time was 165 minutes, with a median hospital stay of 3 days.

Conclusions:

• Peroperative ES is a safe and effective technique for managing choledocholithiasis during laparoscopic cholecystectomy.
• This approach facilitates simultaneous stone clearance, potentially streamlining patient care.
• Further evaluation may solidify its role as a preferred method in select cases.