Clinical Review of the Management of Cholelithiasis & Choledocholithiasis

ABSTRACT

The laparoscopic cholecystectomy has been rapidly accepted as the standard treatment for gallbladder stones because its minimally invasive nature offers a significant advantage over an open cholecystectomy in terms of postoperative morbidity & recovery. The endoscopic sphinterotomy has become the primary treatment for common bile duct stones, yielding a duct clearance rate of approximately 90%. The laparoscopic cholecystectomy combined with the preoperative endoscopic sphinterotomy is becoming more widely employed as a therapeutic option for the management of gallbladder stones & common bile-duct stones. The authors retrospectively analyzed 71 patients who had been treated by an open cholecystectomy and a common bile-duct exploration (group A) and 35 patients who had been treated by a laparoscopic cholecystectomy plus endoscopic sphinterotomy (group B) at the Department of Surgery, Jungang Gil Hospital, from March 1993 to January 1996. The diagnotic procedures performed were ultrasonography ERC and DISIDA scan, and abdominal computed tomography. Intraoperative cholangiograms were successfully performed in 59 cases from group A and in 5 cases from group B. Successful duct clearance was achieved in 87.3% of the group A cases and in 87.5% of the group B cases. The operation time, the postoperative hospital stay, and postoperative complications were significantly lower for group B than for group A. The major postoperative complication was wound pain & infection for both groups. We conclude that in comparison with group A, group B appeared to have a similar clearance rate, a much lower morbidity, a shorter hospital stay, an earlier return to working fitness, and a better cosmetic result.