The Effectiveness of a Preoperative Endoscopic Sphincterotomy before the Laparoscopic Cholecystectomy

Song, Tae Jin; Chung, Ki Hoon; Chae, Ki Bong; Choi, Won Jun; Kim, Chang Duck; Choi, Sang Yong; Suh, Sung Ok; Kim, Young Chul

Abstract

BACKGROUND/AIMS
There are some options which exist in the optimal treatment of Common Bile Duct (CBD) stones. The management of CBD stones by a preoperative Endoscopic Sphincterotomy (EST) and a Laparoscopic Cholecystectomy (LC) remains controveraial. This study intends to investigate the value of an EST before an LC in patients with CBD stones compared with a conventional Open Cholecystectomy (OC) with a Common Bile Duct Exploration (CBDE).
METHODS
Sixty three patients underwent an EST before an LC, while 65 patients received an OC with a CBDE were reviewed retrospectively for a 42 month period from January, 1993 to June, 1996.
RESULTS
There was no statistical significance of stone numbers and sizes in both groups (p>0.05), but the EST before the LC group a showed a shorter hospital stay (12.2 days:19.8 days, p < 0.05). The complication rate in conventional OC with the CBDE group was greater but it was not statistically significant(p>0.05). Rate of stone recurrence and remnant stones in the OC with CBDE group (50.8%) was ater than the EST before LC group (25.4%)(p <0.05). The total hospitalization fee in the EST before LC group was lesser than the OC with CBDE group (p<0.05).
CONCLUSIONS
An EST before an LC is a valuable option for patients with gall stones and simultaneous choledocholithiasis and is suitable according to recent trends in the minimal invasive approach. It needs however, larger group evaluation in order to determine the accurate indications and proper patient selection for this procedure.