One-Session Laparoscopic Management of Combined Common Bile Duct and Gallbladder Stones Versus Sequential ERCP Followed by Laparoscopic Cholecystectomy.

AIM

This study aimed to evaluate the efficacy and safety of laparoscopic management of common bile duct (CBD) stones in a single session in comparison with two-session procedures including endoscopic retrograde cholangiopancreatography (ERCP) and laparoscopic cholecystectomy (LC). The most popular approach to treat CBD stones that were detected before LC is with ERCP followed by LC. This two-session approach has some disadvantages, which include spontaneous passage of stones found on magnetic resonance cholangiopancreatography while awaiting ERCP, the risk for CBD stone passage between ERCP and LC or during LC due to excessive gallbladder handling, and the need for multiple anesthesia sessions and hospital admissions within a short interval.

PATIENTS AND METHODS

A prospective outcome analysis was done for 150 patients with CBD stones treated either laparoscopically in a single session with either transcystic exploration (conducted in 23 cases) or CBD exploration (conducted in 46 cases) (Group I included 75 patients) or via two sessions using ERCP followed by cholecystectomy (Group II included 75 patients).

RESULTS

The rate of CBD clearance in Group I was 94.7%, whereas it was 97% in Group II. Group I is superior to Group II with regard to the operative time. There were no significant differences between the two groups regarding conversion to the open procedure, hospital stay, or postoperative complications.

CONCLUSIONS

The single-session laparoscopic management of CBD stones is as safe and effective as the gold standard sequential ERCP followed by LC with nearly the same rate of success, hospital stay, and complications.