Advertisement

Updates in Surgery

, Volume 67, Issue 4, pp 449–454 | Cite as

“Ultra-rapid” sequential treatment in cholecystocholedocholithiasis: alternative same-day approach to laparoendoscopic rendezvous

  • Dario BorrecaEmail author
  • Alberto Bona
  • Maria Paola Bellomo
  • Andrea Borasi
  • Paolo De Paolis
Original Article

Abstract

There is still no consensus about timing of laparoscopic cholecystectomy after endoscopic retrograde cholangiopancreatography in the treatment of cholecystocholedocholithiasis. The aim of our retrospective study is to analyze the optimal timing of surgical treatment in patients presenting concurrent choledocholithiasis, choosing to perform a sequential endoscopic plus surgical approach, introducing a same-day two-stage alternative. All cases of cholecystocholedocholithiasis occurred between January 2007 and December 2014 in “Gradenigo” Hospital (Turin—Italy) were reviewed. Patients were divided into three groups, based on the timing of cholecystectomy after endoscopic retrograde cholangiopancreatography, and compared. Out of 2233 cholecystectomies performed in the mentioned time interval, have been identified 93 patients that fulfill the selection criteria. 36 patients were treated with a same-day approach, while 29 within first 72 h and 28 with delayed surgery. The overall length of stay was significantly lower in patients that were treated with a same-day approach (4.7 days), compared with other groups (p = 0.001), while no significant differences were found in terms of length of surgical intervention, intraoperative complications and conversions to open procedure, postoperative stay, morbidity and mortality. Patients treated with delayed surgery had a 18 % recurrency rate of biliary events, with an odds ratio of 14.13 (p = 0.018). Same-day two-stage approach should be performed in suitable patients at the index admission, reducing overall risks, improving the patients’ quality-of-life, preventing recurrency, leading to a significant cost abatement; furthermore, this approach allows same outcomes of laparoendoscopic rendezvous, avoiding technical and organizational troubles.

Keywords

Choledocholithiasis Timing Cholecystectomy Sequential 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standard

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Research involving human participants and/or animals

This article does not contain any studies with animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Waage A, Stromber C, Leijonmarck CE, Arvidsson D (2003) Long-term results from laparoscopic common bile duct exploration. Surg Endosc 17:1181–1185PubMedCrossRefGoogle Scholar
  2. 2.
    Dorman JP, Franklin ME, Glass JL (1998) Laparoscopic common bile duct exploration by choledochotomy. An effective and efficient method of treatment of choledocholithiasis. Surg Endosc 12:926–928PubMedCrossRefGoogle Scholar
  3. 3.
    Tzovaras G, Baloyiannis I, Zachari E, Symeonidis D, Zacharoulis D, Kapsoritakis A, Paroutoglou G, Potamianos S (2012) Laparoendoscopic rendezvous versus preoperative ERCP and laparoscopic cholecystectomy for the management of cholecysto-choledocholihiasis. Ann Surg 255:435–439PubMedCrossRefGoogle Scholar
  4. 4.
    Salman B, Ylmaz U, Kerem M, Bedirli A (2009) The timing of laparoscopic cholecystectomy after endoscopic retrograde cholangiopancreaticography in cholelithiasis coexisting with choledocholithiasis. J Hepatobiliary Pancreat Surg 16(6):832–836PubMedCrossRefGoogle Scholar
  5. 5.
    Schiphorst AH, Besselink MG, Boerma D, Timmer R, Wiezer MJ, van Erpecum KJ, Broeders IA, van Ramshorst B (2008) Timing of cholecystectomy after endoscopic sphincterotomy for common bile duct stones. Surg Endosc 22(9):2046–2050PubMedCrossRefGoogle Scholar
  6. 6.
    Reinders JS, Goud A, Timmer R, Kruyt PM, Witteman BJM, Smakman N, Breumelhof R, Donkervoort SC, Jansen JM, Heisterkamp J, Grubben M, Van Ramshorst B, Boerma D (2010) Early laparoscopic cholecystectomy improves outcomes after endoscopic sphincterotomy for choledochocystolithiasis. Gastroenterology 138:2315–2320PubMedCrossRefGoogle Scholar
  7. 7.
    Elixhauser A, Steiner C, Coffey RM (1998) Comorbidity measures for use with administrative data Med. Care 36:8–27CrossRefGoogle Scholar
  8. 8.
    Koc B, Karahan S, Adas G, Tutal F, Guven H, Ozsoy A (2013) Comparison of laparoscopic common bile duct exploration and endoscopic retrograde cholangiopancreatography plus laparoscopic cholecystectomy for choledocholithiasis: a prospective randomized study. Am J Surg 206:457–463PubMedCrossRefGoogle Scholar
  9. 9.
    de Vries A, Donkervoort SC, van Geloven AA (2005) Conversion rate of laparoscopic cholecystectomy after endoscopic retrograde cholangiography in the treatment of choledocholithiasis: does the time interval matter? Surg Endosc 19:996–1001PubMedCrossRefGoogle Scholar
  10. 10.
    Boerma D, Schwartz MP (2006) Management of common bile-duct stones and associated gallbladder stones: surgical aspects. Best Pract Res Clin Gastroenterol 20(6):1103–1116PubMedCrossRefGoogle Scholar
  11. 11.
    Poulose KB, Speroff T, Holzman MD (2007) Optimizing choledocholithiasis management. A cost-effectiveness analysis. Arch Surg 142:43–48PubMedCrossRefGoogle Scholar
  12. 12.
    Ding YB, Deng B, Liu XN, Wu J, Xiao WM, Wang YZ, Ma JM, Li Q, Ju ZS (2013) Synchronous vs sequential laparoscopic cholecystectomy for cholecystocholedocholithiasis. World J Gastroenterol 19(13):2080–2086PubMedCentralPubMedCrossRefGoogle Scholar
  13. 13.
    Morino M, Baracchi F, Miglietta C, Furlan N, Ragona R, Garbarini A (2006) Preoperative endoscopic sphincterotomy versus laparoendoscopic rendezvous in patients with gallbladder and bile duct stones. Ann Surg 244:889–896PubMedCentralPubMedCrossRefGoogle Scholar
  14. 14.
    Paganini AM, Guerrieri M, Sarnari J, De Sanctis A, D’Ambrosio G, Lezoche G, Lezoche E (2005) Long-term results after laparoscopic transverse choledochotomy for common bile duct stones. Surg Endosc 19:705–709PubMedCrossRefGoogle Scholar
  15. 15.
    Sugiyama M, Atomi Y (1999) Does endoscopic sphincterotomy causes prolonged pancreatobiliary reflux? Am J Gastroenterol 94:795–798PubMedCrossRefGoogle Scholar
  16. 16.
    Boerma D, Rauws EA, Keulemans YC (2002) Wait-and-see policy or laparoscopic cholecystectomy after endoscopic sphincterotomy for bile duct stones: a randomized trial. Lancet 360:761–765PubMedCrossRefGoogle Scholar
  17. 17.
    Hong DF, Xin Y, Chen DW (2006) Comparison of laparoscopic cholecystectomy combined with intraoperative endoscopic sphincterotomy and laparoscopic exploration of the common bile duct for cholecystocholedocholithiasis. Surg Endosc 20:424–427PubMedCrossRefGoogle Scholar
  18. 18.
    Rogers SJ, Cello JP, Horn JK, Siperstein AE, Schecter WP, Campbell AR, Mackersie RC, Rodas A, Kreuwel HT, Harris HW (2010) Prospective randomized trial of LC+LCBDE vs ERCP/S+LC for common bile duct stone disease. Arch Surg 145:28–33PubMedGoogle Scholar
  19. 19.
    Lu J, Cheng Y, Xiong XZ, Lin YX, Wu SJ, Cheng NS (2012) Twostage vs single-stage management for concomitant gallstones and common bile duct stones. World J Gastroenterol 18:3156–3166PubMedCentralPubMedCrossRefGoogle Scholar
  20. 20.
    La Greca G, Barbagallo F, Sofia M, Latteri S, Russello D (2010) Simultaneous laparoendoscopic rendezvous for the treatment of cholecystocholedocholithiasis. Surg Endosc 24:769–780CrossRefGoogle Scholar
  21. 21.
    Li VKM, Yum JLK, Yeung YP (2010) Optimal timing of elective laparoscopic cholecystectomy after acute cholangitis and subsequent clearance of choledocholithiasis. Am J Surg 200:483–488PubMedCrossRefGoogle Scholar
  22. 22.
    Bostanci EB, Ercan M, Ozer I, Teke Z, Parlak E, Akoglu M (2010) Timing of elective laparoscopic cholecystectomy after endoscopic retrograde cholangiopancreatography with sphincterotomy: a prospective observational study of 308 patients. Lang. Arch. Surg. 395:661–666CrossRefGoogle Scholar
  23. 23.
    Cuschieri A, Croce E, Faggioni A, EAES ductal stone study (1996) Preliminary findings of multi-center prospective randomized trial comparing two-stage vs single-stage management. Surg Endosc 10:1130–1135PubMedCrossRefGoogle Scholar
  24. 24.
    Allen NL, Leeth RR, Finan KR, Tishler DS, Vickers SM, Wilcox CM, Hawn MT (2006) Outcomes of cholecystectomy after endoscopic sphincterotomy for choledocholithiasis. J Gastr Surg 10:292–296CrossRefGoogle Scholar
  25. 25.
    Neoptolemos JP, Shaw DE, Carr-Locke DL (1989) A multivariate analysis of preoperative risk factors in patients with common bile duct stones. Implications for treatment. Ann Surg 209:157–161PubMedCentralPubMedCrossRefGoogle Scholar
  26. 26.
    Lezoche E, Paganini AM, Carlei F (1996) Laparoscopic treatment of gallbladder and common bile duct stones: a prospective study. World J Surg 20:535–541PubMedCrossRefGoogle Scholar
  27. 27.
    Martin DJ, Vernon DR, Toouli J (2006) Surgical versus endoscopic treatment of bile duct stones. Cochrane Database Syst Rev 2:CD003327PubMedGoogle Scholar

Copyright information

© Italian Society of Surgery (SIC) 2015

Authors and Affiliations

  • Dario Borreca
    • 1
    Email author
  • Alberto Bona
    • 1
  • Maria Paola Bellomo
    • 1
  • Andrea Borasi
    • 1
  • Paolo De Paolis
    • 1
  1. 1.Department of General Surgery“Gradenigo” HospitalTurinItaly

Personalised recommendations