BACKGROUND: No unanimous consensus has been achieved regarding the ideal management of cholecystocholedocholithiasis. The treatment of gallbladder and common bile duct (CBD) stones may be achieved currently according to a two-step-protocol (endoscopic sphincterotomy associated with laparoscopic cholecystectomy) or by a one-step laparoscopic procedure, including exploration of the CBD and cholecystectomy. Endoscopic sphincterotomy is reported to have considerable morbidity/mortality and CBD stone recurrence rates, whereas laparoscopic CBD clearance is a demanding procedure, which to date has not spread beyond specialized environments. METHODS: To evaluate our "laparoscopy first" (LF) approach for patients affected by gallbladder/CBD stones (laparoscopic exploration and intraoperative decision whether to proceed with laparoscopic CBD exploration or to postpone CBD stone treatment to a postoperative endoscopic retrograde cholangiopancreatography [ERCP]), we performed a retrospective, two-center case-control comparison of the postoperative outcome for 49 consecutive patients treated for gallbladder/CBD stones from January 2000 through December 2004. The results obtained with this LF approach were compared with those achieved with the traditional, "endoscopy-first" (EF) approach (ERCP plus endoscopic sphincterotomy, followed by laparoscopic cholecystectomy). The mean follow-up period was 6.4 years (range, 4-8 years). RESULTS: No difference emerged concerning early and late complications, mortality, or laparotomies needed to accomplish cholecystectomy and CBD clearance. The postoperative hospital stay was shorter for the LF group. In the LF group, only 22 patients underwent choledochotomy (45%), and 15 patients underwent perioperative ERCP (30%). Conversions decreased with practice. After choledochotomy, an increasing number of patients underwent primary closure of the CBD (with no biliary drain), without complications. CONCLUSIONS: An LF approach to gallbladder/CBD stones is safe and feasible. It may allow the majority of surgeons to avoid excessively difficult/dangerous surgical procedures as well as unnecessary ERCPs in most cases. A tendency toward a lower incidence of conversions and a rarer use of biliary drains may lead to an improved immediate outcome for patients undergoing an LF approach.

CHOLECYSTO-CHOLEDOCHAL LITHIASIS: A CASE-CONTROL COMPARISON OF EARLY AND LONG-TERM OUTCOME OF A “LAPAROSCOPY-FIRST” ATTITUDE VS. SEQUENTIAL TREATMENT (SYSTEMATIC ENDOSCOPIC SPHINCTEROTOMY FOLLOWED BY LAPAROSCOPIC CHOLECYSTECTOMY) / Costi, Renato; Mazzeo, A; Tartamella, Francesco; Manceau, C; Vacher, B; Valverde, A.. - In: SURGICAL ENDOSCOPY. - ISSN 0930-2794. - 24:(2010), pp. 51-62. [10.1007/s00464-009-0511-6]

CHOLECYSTO-CHOLEDOCHAL LITHIASIS: A CASE-CONTROL COMPARISON OF EARLY AND LONG-TERM OUTCOME OF A “LAPAROSCOPY-FIRST” ATTITUDE VS. SEQUENTIAL TREATMENT (SYSTEMATIC ENDOSCOPIC SPHINCTEROTOMY FOLLOWED BY LAPAROSCOPIC CHOLECYSTECTOMY).

COSTI, Renato;TARTAMELLA, Francesco;
2010-01-01

Abstract

BACKGROUND: No unanimous consensus has been achieved regarding the ideal management of cholecystocholedocholithiasis. The treatment of gallbladder and common bile duct (CBD) stones may be achieved currently according to a two-step-protocol (endoscopic sphincterotomy associated with laparoscopic cholecystectomy) or by a one-step laparoscopic procedure, including exploration of the CBD and cholecystectomy. Endoscopic sphincterotomy is reported to have considerable morbidity/mortality and CBD stone recurrence rates, whereas laparoscopic CBD clearance is a demanding procedure, which to date has not spread beyond specialized environments. METHODS: To evaluate our "laparoscopy first" (LF) approach for patients affected by gallbladder/CBD stones (laparoscopic exploration and intraoperative decision whether to proceed with laparoscopic CBD exploration or to postpone CBD stone treatment to a postoperative endoscopic retrograde cholangiopancreatography [ERCP]), we performed a retrospective, two-center case-control comparison of the postoperative outcome for 49 consecutive patients treated for gallbladder/CBD stones from January 2000 through December 2004. The results obtained with this LF approach were compared with those achieved with the traditional, "endoscopy-first" (EF) approach (ERCP plus endoscopic sphincterotomy, followed by laparoscopic cholecystectomy). The mean follow-up period was 6.4 years (range, 4-8 years). RESULTS: No difference emerged concerning early and late complications, mortality, or laparotomies needed to accomplish cholecystectomy and CBD clearance. The postoperative hospital stay was shorter for the LF group. In the LF group, only 22 patients underwent choledochotomy (45%), and 15 patients underwent perioperative ERCP (30%). Conversions decreased with practice. After choledochotomy, an increasing number of patients underwent primary closure of the CBD (with no biliary drain), without complications. CONCLUSIONS: An LF approach to gallbladder/CBD stones is safe and feasible. It may allow the majority of surgeons to avoid excessively difficult/dangerous surgical procedures as well as unnecessary ERCPs in most cases. A tendency toward a lower incidence of conversions and a rarer use of biliary drains may lead to an improved immediate outcome for patients undergoing an LF approach.
2010
CHOLECYSTO-CHOLEDOCHAL LITHIASIS: A CASE-CONTROL COMPARISON OF EARLY AND LONG-TERM OUTCOME OF A “LAPAROSCOPY-FIRST” ATTITUDE VS. SEQUENTIAL TREATMENT (SYSTEMATIC ENDOSCOPIC SPHINCTEROTOMY FOLLOWED BY LAPAROSCOPIC CHOLECYSTECTOMY) / Costi, Renato; Mazzeo, A; Tartamella, Francesco; Manceau, C; Vacher, B; Valverde, A.. - In: SURGICAL ENDOSCOPY. - ISSN 0930-2794. - 24:(2010), pp. 51-62. [10.1007/s00464-009-0511-6]
File in questo prodotto:
File Dimensione Formato  
Costi_Renato_lavoro_ N.5.pdf

non disponibili

Tipologia: Altro materiale allegato
Licenza: NON PUBBLICO - Accesso privato/ristretto
Dimensione 256.17 kB
Formato Adobe PDF
256.17 kB Adobe PDF   Visualizza/Apri   Richiedi una copia

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11381/2319803
Citazioni
  • ???jsp.display-item.citation.pmc??? ND
  • Scopus 35
  • ???jsp.display-item.citation.isi??? 36
social impact