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Dig Liver Dis. 2017 Jul;49(7):773-779. doi: 10.1016/j.dld.2017.02.016. Epub 2017 Mar 22.

How can recovery be enhanced after single-stage laparoscopic management of CBD stones? Endoscopic treatment versus laparoscopic surgery.

Author information

1
Department of Digestive and Oncological Surgery, Amiens University Medical Center and Jules Verne University of Picardie, Amiens, France.
2
Department of Digestive Surgery, Mutualist clinics, Lorient, France.
3
Department of Gastroenterology, Amiens University Medical Center and Jules Verne University of Picardie, Amiens, France.
4
Department of Digestive and Oncological Surgery, Amiens University Medical Center and Jules Verne University of Picardie, Amiens, France; EA4294, Jules Verne University of Picardie, Amiens, France; Clinical Research Centre, Amiens University Medical Center and Jules Verne University of Picardie, Amiens, France. Electronic address: regimbeau.jean-marc@chu-amiens.fr.

Abstract

BACKGROUND:

Single-stage management of CBD stones comprises simultaneous common bile duct (CBD) clearance and cholecystectomy. The CBD can be cleared by using endoscopic treatment (ET) or laparoscopic surgery (LS) alone.

AIMS:

To determine the most rapid recovery after the single-stage laparoscopic management of CBD stones.

METHODS:

Patients with CBD stones treated at either of two centers (one performing ET only and one performing LS only for single-stage treatment) were included. The primary endpoint was "the textbook outcome".

RESULTS:

The feasibility rate was 74% for ET and 100% for LS (p≤0.001). The proportion of cases with the textbook outcome was higher in the ET group than in the LS-only group (73% vs. 10%; p<0.001). The CBD clearance rate was similar in the ET and LS-only groups (100% vs. 96.6%, respectively; p=0.17). The overall morbidity rate was lower in the ET group than in the LS-only group (23% vs. 29%, p=0.05).

CONCLUSION AND RELEVANCE:

Both ET and LS are feasible, safe and effective for clearance of the CBD. ET was better than LS in terms of a less frequent requirement for drainage and a shorter length of hospital stay. LS was associated with a shorter operating time.

KEYWORDS:

Common Bile duct stones; Endoscopic treatment

PMID:
28389089
DOI:
10.1016/j.dld.2017.02.016
[Indexed for MEDLINE]

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