[Preoperative therapeutic splitting]

Area of Science:

• Gastroenterology
• Surgical Innovation

Background:

• The optimal clinical strategy for combining Endoscopic Retrograde Cholangiopancreatography (ERC) and Laparoscopic Cholecystectomy (LC) remains undetermined.
• This study critically analyzes laparoscopic bile duct exploration and correlates findings with a prospective study on
• therapeutical splitting
• .

Purpose of the Study:

• To critically analyze laparoscopic bile duct exploration.
• To correlate these findings with a prospective study evaluating
• therapeutical splitting
• .

Main Methods:

• A prospective study of 1645 patients with symptomatic gall stone disease.
• Patients underwent ultrasound examination; 309 had open cholecystectomy due to prior surgery or perforation.
• Patients with high probability of common bile duct stones or biliary pancreatitis underwent ERC, Endoscopic Papillotomy (EPT), and stone extraction; 1336 patients had attempted LC.

Main Results:

• Among 260 patients undergoing endoscopy, 70% required EPT and/or stone extraction, with 95% subsequently undergoing laparoscopic gallbladder removal.
• Morbidity was 3% with no mortality in the endoscopic group (including biliary pancreatitis patients).
• In the non-endoscopic group (1076 patients), conversion rate was 6.8%, morbidity 4.3%, and mortality 0.09%, with 0.5% residual stones.

Conclusions:

• Therapeutical splitting is the current method of choice.
• This approach is effective when selection criteria for bile duct pathology demonstrate high sensitivity and specificity.
• A high endoscopic stone clearance rate is crucial for successful therapeutic splitting.