Emilie Chapuis-Roux1, Laurent Pellissier2, Francois Browet1, Jean Charles Berthou2, Sami Hakim3, Franck Brazier3, Cyril Cosse1, Richard Delcenserie3, Jean Marc Regimbeau4. 1. Department of Digestive and Oncological Surgery, Amiens University Medical Center and Jules Verne University of Picardie, Amiens, France. 2. Department of Digestive Surgery, Mutualist clinics, Lorient, France. 3. Department of Gastroenterology, Amiens University Medical Center and Jules Verne University of Picardie, Amiens, France. 4. Department of Digestive and Oncological Surgery, Amiens University Medical Center and Jules Verne University of Picardie, Amiens, France; EA4294, Jules Verne University of Picardie, Amiens, France; Clinical Research Centre, Amiens University Medical Center and Jules Verne University of Picardie, Amiens, France. Electronic address: regimbeau.jean-marc@chu-amiens.fr.
Abstract
BACKGROUND: Single-stage management of CBD stones comprises simultaneous common bile duct (CBD) clearance and cholecystectomy. The CBD can be cleared by using endoscopic treatment (ET) or laparoscopic surgery (LS) alone. AIMS: To determine the most rapid recovery after the single-stage laparoscopic management of CBD stones. METHODS: Patients with CBD stones treated at either of two centers (one performing ET only and one performing LS only for single-stage treatment) were included. The primary endpoint was "the textbook outcome". RESULTS: The feasibility rate was 74% for ET and 100% for LS (p≤0.001). The proportion of cases with the textbook outcome was higher in the ET group than in the LS-only group (73% vs. 10%; p<0.001). The CBD clearance rate was similar in the ET and LS-only groups (100% vs. 96.6%, respectively; p=0.17). The overall morbidity rate was lower in the ET group than in the LS-only group (23% vs. 29%, p=0.05). CONCLUSION AND RELEVANCE: Both ET and LS are feasible, safe and effective for clearance of the CBD. ET was better than LS in terms of a less frequent requirement for drainage and a shorter length of hospital stay. LS was associated with a shorter operating time.
BACKGROUND: Single-stage management of CBD stones comprises simultaneous common bile duct (CBD) clearance and cholecystectomy. The CBD can be cleared by using endoscopic treatment (ET) or laparoscopic surgery (LS) alone. AIMS: To determine the most rapid recovery after the single-stage laparoscopic management of CBD stones. METHODS: Patients with CBD stones treated at either of two centers (one performing ET only and one performing LS only for single-stage treatment) were included. The primary endpoint was "the textbook outcome". RESULTS: The feasibility rate was 74% for ET and 100% for LS (p≤0.001). The proportion of cases with the textbook outcome was higher in the ET group than in the LS-only group (73% vs. 10%; p<0.001). The CBD clearance rate was similar in the ET and LS-only groups (100% vs. 96.6%, respectively; p=0.17). The overall morbidity rate was lower in the ET group than in the LS-only group (23% vs. 29%, p=0.05). CONCLUSION AND RELEVANCE: Both ET and LS are feasible, safe and effective for clearance of the CBD. ET was better than LS in terms of a less frequent requirement for drainage and a shorter length of hospital stay. LS was associated with a shorter operating time.