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Choledocholithiasis: endoscopic versus laparoscopic management

M J Heili1, N K Wintz, D L Fowler

  • 1Department of Surgery, Gastonia Medical Center, North Carolina, USA.

The American Surgeon
|February 2, 1999
PubMed
Summary
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Laparoscopic common bile duct exploration (LSCBDE) is a superior treatment for choledocholithiasis compared to endoscopic retrograde cholangiopancreatography with endoscopic retrograde sphincterotomy (ERCP/ERS). LSCBDE offers shorter hospital stays, lower costs, and fewer complications.

Area of Science:

  • Gastroenterology
  • Surgical Innovation
  • Biliary Tract Disease

Background:

  • Choledocholithiasis affects 6-10% of patients with gallstones.
  • Laparoscopic cholecystectomy is a common procedure.
  • ERCP/ERS and LSCBDE are established treatments for common bile duct stones.

Purpose of the Study:

  • To compare the efficacy and outcomes of ERCP/ERS and LSCBDE for treating choledocholithiasis.
  • To evaluate hospital length of stay, cost, and complication rates between the two procedures.

Main Methods:

  • Retrospective review of 61 patients with choledocholithiasis.
  • Patients underwent either ERCP/ERS (n=26) or LSCBDE (n=35).
  • Data collected included hospital length of stay, cost, and complication rates.

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Main Results:

  • LSCBDE group had a significantly shorter hospital length of stay (3.4 days vs 5.0 days, P=0.028).
  • LSCBDE group experienced significantly fewer complications (2.9% vs 23.1%, P=0.034).
  • LSCBDE was associated with lower hospital costs ($9,100 vs $11,823, P=0.066).

Conclusions:

  • Laparoscopic common bile duct exploration (LSCBDE) demonstrates superior outcomes compared to ERCP/ERS.
  • LSCBDE should be considered the gold standard for managing choledocholithiasis when feasible.
  • The findings support LSCBDE for reduced patient morbidity and healthcare costs.