Trattamento laparoscopico in tempo unico della litiasi colecisto-coledocica in 268 pazienti consecutivi non selezionati Trattamento laparoscopico in tempo unico della litiasi colecisto-coledocica in 268 pazienti consecutivi non selezionati

Abstract

Aims. The introduction of laparoscopic cholecystectomy (LC) has modified the treatment of gallstones and common bile duct (CBD) stones. Aim of this prospective study was to evaluate the results of single stage laparoscopic management of gallstones and CBD stones.

Patient and methods. From January 1991 to October 1999, CBD stones were present at intraoperative cholangiography in 268 patients (pts) (169 females, 99 males, mean age 55.6 years, range12-94 years) out of 2693 undergoing LC (10%) for gallstones. CBD stones were unsuspected in 123 (45.9%) and suspected in 145 (54.1%).

Results. CBD exploration was successful in 264 cases (98.5%) (trancycstic 164, choledochotomy 100). Four pts were con verted to open surgery (1.5%). Retained stones in 15 patiens (5.7%), were treated by ERCP/ES (6 pts) and by percuta neous endoscopic/fluoroscopic stone removal (6 pts).

Spontaneous stones passage occurred in 2 pts, one patient is waiting for treatment. Major morbidities were hemoperito neum (4 cases) and cystic duct bile leakage (3 cases). One high risk patient died postoperatively. Recurrent stones were observed in 5 pts (1.9%), at 1, 4, 8, 18, 26 months respec tively after T-tube removal, and were treated by ERCP/ES in 4 cases. Spontaneous stone passage occurred in 1 case.

Conclusions. LC and CBD exploration has shown to be safe and feasible with low morbidity and mortality. The rationale of this approach is to solve two problems during the same procedure, limiting the role of endoscopic sphincterotomy to the treatment of residual ductal stones.