Gallstones and common bile duct stones: single or separatedstep endoscopic retrograde cholangiopancreatography and laparoscopic cholecystectomy?

Tóm tắt

Purpose: the treatment of concomitant gallstones and common bile duct (CBD) stones by endoscopic retrograde cholangiopancreatography (ERCP) following laparoscopic cholecystectomy (LC). The analysis of single-step or separated-step characteristics. Object: during the three years (2015-2017), 68 patients having CBD stones concomitant gallstones suitable criteria for inclusion at Hue Central Hospital. Retrospective clinical description study. Results: the average age is 52.2 (tolerance: 12.5) years (24-90) and the male/female ratio is 0.7/1 (27/41). Abdominal pain was the most common symptom 91.2%, which was followed by jaundice 51.5%; direct bilirubin increased by 27.3 (tolerance: 15.6) micromol/l (2.2-165). The size of CBD stones is 12.4 (tolerance: 3.2) mm (6-20), the size of gallstones is 11.3 (tolerance: 6.2) mm (5-36). The first time CBD stones 95.6%, recurrent CBD stones 4.4%. Single-step ERCP and LC 34 patients, separated-step group: ERCP 1.4 (tolerance: 2.5) times and secondary LC. Single-step ductal clearance 76.5%, separated-step ductal clearance 94.1% (p=0.041). Length of hospital stay 6.5 (tolerance: 4.3) days and 13.6 (tolerance: 2.2) days (p<0.0001). Conclusions: the rate of ductal clearance in the separated-step group was significantly higher than the single-step group with p=0.041. The indication of laparoscopic cholecystectomy immediately ERCP should be based on the patient's morbidity, the ductal clearance as well as the prognostic complications of ERCP.