Comparison of open choledocholithotomy with endoscopic sphincterotomy / 中华肝胆外科杂志

ABSTRACT

ObjectiveTo compare the efficacy and health economics between open choledocholithotomy and endoscopic sphincterotomy (EST) these two operations on patients with choledocholithiasis. Methods177 patients (aged 20-75 yrs, with simple choledocholithiasis on medical imaging,who had not been treated with either biliary tract surgery or EST, and had no severe complications)were treated electively at the Beijing Friendly Hospital and Beijing Jishuitan Hospital from 2002 to 2009. These patients were divided into two groups according to the treatment they received open operation (n=62), or EST (n=115). There was no significant difference in sex, age, ASA class,symptoms before operation, and complications before operation between the 2 groups. The following data were compared operation time, blood loss, size and number of stone, duration of postoperative ileus, duration of abdominal pain, incidence of postoperative complications, duration of hospitalization, cost of hospitalization and operation, and incidence of residual stones. ResultsFor the open operation group, the operation time was 50-300 min (M=110), the blood loss was 10-300 ml (M=60), the duration of post-operative ileus was 24-96 h(M=48), the duration of abdominal pain was 0-96 h(M=48), the duration of hospitalization was 8-70 d(M=21), the duration of hyperamylasemia after operation was 8.1％ and the cost for operation was 546-2498 yuan (M=1503. 2). For the EST group, the operation time was 10-120 min (M=25), the blood loss was 2-40 ml (M=10),the duration of post-operative ileus was 1-48 h (M=3), the duration of abdominal pain was 0-144 h (M-0), the period of hospitalization was 5-56 d (M=17), the duration of hyperamylasemia after operation was 40％ and the cost for operation was 2028-5728 yuan (M=2028). There were significant differences in every aspect between these 2 groups of patients. Conclusions EST has a significantly shorter operation time, less blood loss, shorter duration of postoperative ileus, shorter duration of abdominal pain, shorter duration of hospitalization. However, EST had a significantly higher incidence of hyperamylasemia after operation and the cost was higher than open operation.