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Step-Wise Increasing Surgical Complexity in Single-Stage Treatment of Gallbladder and Bile Duct Stones
Aldo Bove*
university of chieti, Chieti, Italy
Introduction
While laparoscopic cholecistectomy (CL) is accepted as the treatment of choice for simple gallbladder stones , the preferred treatment is still debated in the 10% of cases in which common bile duct stones are also present .
The development of laparoscopic techniques also demonstrated that it was possible to resolve both gallbladder and bile duct stones with a single procedure .
Approach in a single step is particularly interesting because it has not been standardized and presents various technical options that require a varying degree of complexity, from both a manual and technological viewpoint, that depends on the method.
The aim of this study was to evaluate results of single stage treatment of gallbladder and bile duct stones using a step-wise increasing surgical complexity: from simple trans-cystic procedure (TC-CBDE) to real complex rendezvous intraoperative papillotomy (RV-IOERC).
METHOD
From January 2005 to June 2014 2745 patients underwent laparoscopic cholecystectomy and in 285 patients (155 women, 123 men, mean age 52 years and range from 24 to 82) common bile duct stones were also present. 278 of the latter group underwent cholecystectomy and bile duct clearance in a single stage treatment.
The principal outcome was successful single stage treatment. Secondary outcomes were intra and post-operative complications, length of surgery, hospital stay. Statistical analysis was performed with Spearman's rank correlation.
Results
The rate to conversion to open surgery was 5% (15 patients). The efficacy of TC-CBDE was 75% (210 patients) while the remaining 53 patients underwent RV-IOERC with an efficacy of 85% (45 patients).
Overall, treatment was possible in a single-stage in 255 (92.3%) patients. The number of intra- and post-operative complications between the two techniques was not statistically significant. Only the intra-operative time was statistically greater for the patients who underwent RV-IOERC.
Conclusion
Single stage treatment of gallbladder and bile duct stones was possible in 92.3% of cases using, in the majority of cases, only TC-CBDE and reserving RV-IOERC for the more complicated cases.
All available options must be available to the surgical team, which must necessarily be multidisciplinary, including surgeons, endoscopists and radiologists, in order to choose the best option for a truly personalized surgery.
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