ISSN:
1432-2218
Keywords:
Key words: Bile duct stones — Laparoscopic cholecystectomy — Endoscopic sphincterotomy — High-risk patient — Elderly
Source:
Springer Online Journal Archives 1860-2000
Topics:
Medicine
Notes:
Abstract Background: 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. Methods: 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. Results: 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). Conclusions: Combined ES + LC is an effective alternative to open surgery or ES alone for treatment of duct stones in high-risk patients.
Type of Medium:
Electronic Resource
URL:
http://dx.doi.org/10.1007/s004649900409
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