Laparoscopic exploration versus intraoperative endoscopic sphincterotomy for common bile duct stones: a prospective randomized trial.
| Autor: | ElGeidie AA; Gastroenterology Surgical Center, Mansoura University, Mansoura, Egypt. ahmedraoaf@mans.edu.eg, ElShobary MM, Naeem YM |
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| Jazyk: | angličtina |
| Zdroj: | Digestive surgery [Dig Surg] 2011; Vol. 28 (5-6), pp. 424-31. Date of Electronic Publication: 2012 Jan 07. |
| DOI: | 10.1159/000331470 |
| Abstrakt: | Background/aims: Laparoscopic cholecystectomy (LC) combined with intraoperative endoscopic sphincterotomy (IOES) was compared to LC with laparoscopic common bile duct exploration (LCBDE) to define the best single-session minimally invasive treatment for cholecystocholedocholithiasis. Methods: Between June 2009 and December 2010, patients with gallstones and common bile duct (CBD) stones diagnosed by preoperative ultrasonography and magnetic resonance cholangiopancreatography were randomized to LC-LCBDE or LC-IOES. The primary end point was complete clearance of CBD of stones. The secondary end points were operation time, conversion rate, length of hospital stay, complications and mortality. Results: Two hundred and twenty-six patients were eligible. They were randomized to LC-LCBDE (n = 115) and LC-IOES (n = 111). There was no statistically significant difference in the success rate of CBD clearance between the two interventions (92% for LC-LCBDE vs. 97.2% for LC-IOES with a p value >0.05). There were no differences between the two groups in terms of surgical time and postoperative length of stay. Pancreatitis and bleeding sphincterotomy were significantly more prevalent in the LC-IOES group, while bile leakage and retained CBD stones were significantly more prevalent in the LC-LCBDE group. Conclusion: Both LC-IOES and LC-LCBDE were shown to be safe, effective, minimally invasive treatments for cholecystocholedocholithiasis, but the former option may be preferred when facilities and experience in endoscopic therapy exist. (Copyright © 2012 S. Karger AG, Basel.) |
| Databáze: | MEDLINE |
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