Clinical Study: A retrospective case-control study of one-stage laparoscopic vs. endoscopic first management of common bile duct stones

Aim-Background The aim was to present the long-term results of the one-stage laparoscopic procedure for the management of common bile duct lithiasis in comparison with the endoscopic first approach. Methods A retrospective case-control study was performed to determine the outcome of patients treated for common bile duct (CBD) stones from April 1997 through to December 2010. Data of patients with choledocholithiasis undergoing the two treatment modalities, laparoscopic common duct exploration plus cholecystectomy (LC+LCBDE: group A: n=98) vs. (endoscopic retrograde cholangiopancreatography/sphincterotomy and laparoscopic cholecystectomy (ERCP/S+LC: group B: n=112), were matched according to their clinical characteristics (age, sex, ASA score, small/large stones and presence of inflammation). Patients of group A underwent either laparoscopic choledochotomy or trancystic exploration. Our policy was to convert to open choledochotomy only after sequential application of the two treatment modalities (laparoscopic/endoscopic) had failed. Results There were no significant differences between groups in terms of Age, sex, ASA score, small/large stones and presence of inflammation. No significant difference in morbidity was found between groups (Group A: 7.1% vs. Group B: 11%). Conversion to another procedure was mandatory in 12/98 and 17/112 patients of group A and B respectively. The mean follow-up period was 7.8 years (range, 1–12 years). Effective laparoscopic treatment of CBD stones (cholecystectomy and CBD clearance) was possible for 86 of the 98 patients (87.7%), compared with 95 of the 112 patients (84.8%) after the endoscopic approach. Conclusions Our study shows that both endoscopy first and one stage laparoscopic management of CBD lithiasis were highly effective and safe with comparable results.