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

Abstract

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±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±15.6 μmol/l (2.2-165). The size of CBD stones is 12.4±3.2 mm (6-20), the size of gallstones is 11.3±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±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±4.3 days and 13.6±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.