Background
The ideal management of common bile duct stones in the era of laparoscopic cholecystectomy
is controversial. With rapid advances in technology and more experience in laparoscopic
skills, many surgeons are now routinely performing single-stage procedures and questioning
the wisdom of preoperative endoscopic retrograde cholangiopancreotography, with or
without sphincterotomy. The purpose of this study was to compare the success rate,
duration of operating time, clinical results, and duration of hospital stay of a laparoendoscopic
“rendezvous” technique versus antegrade sphincterotomy in patients with cholecystitis-choledocholithiasis.
Methods
Patients with gallbladder and common bile duct stones undergoing laparoscopic cholecystectomy
plus retrograde sphincterotomy (group A; n = 35) were compared retrospectively with
those undergoing laparoscopic cholecystectomy plus antegrade sphincterotomy (group
B; n = 41) at a single institution.
Results
Ductal stone clearance was equivalent in the 2 groups (94% vs 95%; P = .979), as was morbidity (9% vs 5%; P = .545) and conversion (6% vs 5%; P = .877). The median operating time was less in group B (89 vs 117 minutes; P < .0001). There was no significant difference in hospital stay between the 2 groups
(P = .140).
Conclusion
This study suggests that intraoperative sphincterotomy with a combined endoscopic-laparoscopic
approach for the removal of common bile duct stone(s) is safe and effective in routine
surgical practice. Ductal stone(s) clearance, morbidity, and conversion were equivalent
in the 2 groups; antegrade sphincterotomy had a shorter operative time compared with
the rendezvous technique.
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Article info
Publication history
Accepted:
April 16,
2008
Identification
Copyright
© 2008 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
