PMID: 9171121Jun 1, 1997Paper

Prospective evaluation of a minimally invasive approach for treatment of bile-duct calculi in the high-risk patient

Surgical Endoscopy
M TriasJ Teres

Abstract

The best approach to bile duct stones in high-risk patients is controversial. We showed in a randomized trial that open surgery had a morbi-mortality similar to that of endoscopic sphincterotomy alone (ES) and less late biliary complications. The aim of this study was to evaluate a minimally invasive approach to duct stones in high-risk patients compared with open surgery or ES alone. Sixty high-risk patients (mean age 80 years) suspected of duct stones were treated by ES + laparoscopic cholecystectomy (LC). High-risk factors were: age > 70 years, Goldman cardiac index > 13, chronic pulmonary disease, liver cirrhosis, neurologic deficit, and severe obesity. ERCP success was 87%. Duct stones were found in 75%. LC succeeded in 92%. Post-LC stay was 4 days. Overall morbidity was 19% and mortality was 3%. Recurrent symptoms (mean follow-up: 9 months) was 3.6%. When compared with open surgery or ES alone, ES + LC had a similar morbi-mortality, but shorter postop stay (p < 0.001). Late symptoms appeared in 20% after ES alone vs 4% after open surgery or ES plus LC (p < 0.04). Combined ES + LC is an effective alternative to open surgery or ES alone for treatment of duct stones in high-risk patients.

Citations

Jan 2, 2001·Journal of Laparoendoscopic & Advanced Surgical Techniques. Part a·F Tatulli, A Cuttitta
Jun 10, 2008·Age and Ageing·Andrea RiphausTill Wehrmann
Dec 19, 2002·Journal of Clinical Gastroenterology·Robert Michael Stephen MitchellWilliam Dickey
Dec 24, 2002·Surgical Laparoscopy, Endoscopy & Percutaneous Techniques·Fabrizio RomanoFranco Uggeri
Apr 12, 2012·Journal of the Korean Surgical Society·Sung Ryol LeeChang Hak Yoo

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