Clinical

Single laparoscopic approach favored for common bile duct stones

Last Updated: 2010-01-28 14:16:40 -0400 (Reuters Health)

NEW YORK (Reuters Health) - For common bile duct stones, a single laparoscopic procedure combining cholecystectomy with bile duct exploration (LCBDE) is best, new research suggests.

In a randomized trial, the investigators compared that approach to the traditional one in which endoscopic cholangiopancreatography (ERCP) and sphincterotomy are done first, followed by laparoscopic cholecystectomy.

Although both approaches were highly effective in removing common duct stones, LCBDE was associated with shorter hospital stays and lower physician fees in the study.

In their paper in the January Archives of Surgery, Dr. Stanley J. Rogers and colleagues from the University of California, San Francisco, note that preoperative ERCP has been the standard of care for suspected common bile duct stones for the past 30 years. As laparoscopic cholecystectomy has evolved, however, common bile duct exploration has come to be included in the same procedure.

Initially, Dr. Rogers and his colleagues randomized 122 good-risk patients with cholelithiasis and likely choledocholithiasis. Ten were later excluded from the analysis due to protocol violations, leaving 55 in the ERCP group and 57 in the LCBDE group.

The primary outcome - total common bile duct stone clearance rates - did not differ significantly between the two approaches: 98% with ERCP and 88% with LCBDE (p = 0.28).

There were no major complications and only a few minor complications in each group.

The mean time from the first procedure to hospital discharge was 55 hours in the LCBDE group, versus 98 hours in the ERCP group. Median professional fees were significantly higher for ERCP ($6139) than for LCBDE ($4820).

There were no differences between the groups in total hospitalization charges, patient acceptance, or quality of life scores.

"Laparoscopic CBDE eliminates the potential risks of ERCP-associated pancreatitis and the need for another procedure and the associated risks of anesthesia," the investigators note.

"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 conclude. "Therefore, a single surgical procedure for common bile duct stone disease is feasible, cost-effective, and ultimately should be available for most patients."

Arch Surg 2010;145:28-33.