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A Randomized Controlled Comparative Study of Laparoscopic CBD Exploration and Cholecystectomy with Endoscopic Stone Extraction and Cholecystectomy for Choledocholithiasis

Anshuman Kaushal, Senior Consultant & Academic Coordinator, Department of General, MIS & Bariatric Surgery, Artemis Hospitals, Gurgaon, 122001, Haryana, India. , Kaushal Anshumana , Pawan Avinashb , Nagaich Neerajc , Thusoo T.K.d

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New Indian Journal of Surgery 8(3):p 297-304, Jul-Sep 2017. | DOI: https://dx.doi.org/10.21088/nijs.0976.4747.8317.1

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Abstract

With the advent of ERCP in 1974 it provided an alternative to CBDE. The CBD calculi could be removed endoscopically and subsequently only a cholecystectomy needed to be performed. Thus ERCP with Endoscopic sphincterotomy(ERCP-S) gained popularity as it provided an alternative to open CBDE for choledocholithiasis diagnosed preoperatively as well as intraoperatively. However, with the development of better techniques and instrumentation LCBDE is a feasible option now. Subsequent studies showed that LCBDE has similar duct clearance rates and morbidity as compared to ERCP-S followed by LC [5,6]. Therefore, a randomized prospective study with N= 56 was done to compare the efficacy of laparoscopic common bile duct exploration and cholecystectomy versus endoscopic stone extraction and laparoscopic cholecystectomy for cholelithiasis and also to compute complications of the individual procedure.In conclusion, our study shows that both LC+ LCBDE and ERCP-S+LC were equally effective in the management of choledocholithiasis and were equivalent in patient satisfaction. However, the overall duration of hospitalization was longer for LC+ LCBDE. Laparoscopic CBDE significantly reduces the risks of ERCP- associated pancreatitis, anaesthesia and another procedure. Hence, LCBDE+LC is a feasible, cost-effective, and safe procedure and ultimately should be offered as a treatment option for most patients.

 

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DOI: https://dx.doi.org/10.21088/nijs.0976.4747.8317.1

Keywords

Choledocholithiasis; ERCP; Laparoscopic Bile Duct Exploration; Endoscopic Sphincterotomy. 

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