Single Laparoscopic Approach Favored for Common Bile Duct Stones

A new study recommends that for common bile duct stones, a single laparoscopic procedure combining cholecystectomy with bile duct exploration is the best option.

Researchers at the University of California, San Francisco (UCSF; USA) conducted a prospective trial and randomized 122 patients to either a combined laparoscopic cholecystectomy with a laparoscopic common bile duct exploration (LC+LCBDE) or to separate endoscopic retrograde cholangiopancreatography sphincterotomy plus laparoscopic cholecystectomy (ERCP/S+LC). The primary outcome measure was efficacy of stone clearance from the common bile duct; secondary end points were length of hospital stay, cost of index hospitalization, professional fees, hospital charges, morbidity and mortality, patient acceptance, and quality of life (QOL) scores.

The results showed that the primary outcome--total common bile duct stone clearance rates--did not differ significantly between the two approaches: 98% with ERCP/S+LC and 88% with LC+LCBDE. However, the mean time from the first procedure to hospital discharge was 55 hours in the LCBDE group, significantly shorter than the average 98 hours in the ERCP group. There were no major complications and only a few minor complications in each group. There were no significant differences between the groups in patient acceptance or QOL scores. The study was published in the January 2010 issue of Archives of Surgery.

"Laparoscopic CBDE eliminates the potential risks of ERCP-associated pancreatitis and the need for another procedure and the associated risks of anesthesia,” concluded lead author Stanley Rogers, M.D. and colleagues of the department of surgery. "As surgical skill with laparoscopic exploration of the common bile duct increases, the need for routine preoperative ERCP will likely decrease, except in unique high-risk situations.”

The researchers also found that both hospital service, professional charges, and total charges for patient hospitalization and were likewise lower for LC+LCBDE, but that the differences were not statistically significant.

Related Links:
University of California, San Francisco