Management of concomitant gallbladder and common bile duct stones: one stage versus two stages

Mohamed, Hossam Mahmoud Ibrahim; Elkatieb, Abd Elmoniem Mohamed Ismail; Abdallah, Ahmed Mohamed Ali; Elrazik, Mahmoud Hasab Elnabi Abd

doi:10.4103/ejs.ejs_137_23

Management of concomitant gallbladder and common bile duct stones: one stage versus two stages

Authors

Abstract

Background
The ideal management plan for patients diagnosed with concomitant cholelithiasis and choledocholithiasis has been a great matter of debate among hepatobiliary surgeons. Some surgeons prefer a single-stage approach (laparoscopic cholecystectomy LC with laparoscopic common bile duct exploration, LCBDE), while others prefer two-stage approaches (preoperative endoscopic stone extraction followed by interval LC). Herein, we compare the outcomes of the previous two approaches in our Egyptian tertiary care setting.
Methods
Sixty-four patients were eligible for our randomized trial and were randomly assigned into two groups: Group A was scheduled for the single-stage approach and Group B was scheduled for the two-stage approach. Periprocedural outcomes, including success rates, were assessed in the two groups.
Results
Failed stone extraction was encountered in three patients in Group B (success rate 90.62%). However, we were able to completely free the CBD in all patients in Group A (100% success). Operative time was significantly prolonged in Group A (173.13 vs. 75.97 min in Group B). However, Group A patients had a shorter hospitalization period compared with Group B (5 vs. 7 days). Bile leakage was more encountered in Group A, while the incidence of pancreatitis was higher in Group B. All patients were conservatively managed with no further intervention.
Conclusion
A higher, but not statistically significant, success rate was reported with the single-stage approach. Despite this, this technique was preferred due to a shorter hospital stay and higher clearance rates reported in our study.

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