[Does laparoscopy influence the treatment of choledocholithiasis?]

Area of Science:

• Gastroenterology and Hepatobiliary Surgery
• Minimally Invasive Surgical Techniques
• Diagnostic Imaging in Biliary Disease

Background:

• Choledocholithiasis management has evolved with laparoscopic cholecystectomy (LC).
• Traditional two-stage treatments involving preoperative or postoperative endoscopic retrograde cholangiography (ERC) carry additional risks.
• Single-stage approaches integrating common bile duct exploration with LC are increasingly favored.

Purpose of the Study:

• To evaluate the efficacy and safety of laparoscopic common bile duct exploration (LCDE) as a single-stage treatment for choledocholithiasis.
• To compare the diagnostic performance of intravenous cholangiography (IVC) and intraoperative cholangiography (IOC) during LC.
• To assess the outcomes of endoscopic versus laparoscopic management of common bile duct stones.

Main Methods:

• Retrospective review of 550 consecutive patients undergoing LC.
• Analysis of diagnostic accuracy and complication rates for IVC and IOC.
• Comparison of treatment success rates for endoscopic retrograde cholangiography with endoscopic papillotomy (ERC/EP) versus LCDE.

Main Results:

• IVC showed 75% sensitivity and 99% specificity but failed in 5.6% of cases.
• IOC demonstrated high success rates (97.6%) with 95% sensitivity and 100% specificity, adding minimal operative time.
• Of 47 patients with common duct stones, 62% were treated by ERC/EP (94% success) and 38% by LCDE (82% success).

Conclusions:

• Single-stage LCDE is a viable and preferable alternative to two-stage treatments for biliary lithiasis.
• Intraoperative cholangiography (IOC) is a highly accurate and efficient tool for diagnosing common bile duct stones during LC.
• Both endoscopic and laparoscopic approaches can effectively clear common bile duct stones, with varying success rates.