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Comparing One-Stage vs Two-Stage Approaches for the Management of Choledocholithiasis

  • SSAT Plenary Presentation
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

The management of symptomatic choledocholithiasis remains a controversial issue. At present, the three most common management options for choledocholithiasis include a preoperative endoscopic retrograde cholangiopancreatography with sphincterotomy and stone extraction followed by laparoscopic cholecystectomy, then by either an intraoperative endoscopic retrograde cholangiopancreatography with sphincterotomy or a laparoscopic common bile duct exploration. The purpose of this study was to assess the consequences of the decision to pursue each of these three methods.

Methods

We conducted a review of the existing data comparing these three management options. The literature from 2009 to 2021 pertaining to these three methods was reviewed for data on duct clearance, morbidity, mortality, recurrence rate, length of stay, and operative time. Next, we constructed decision trees for each method using a utility score analysis, and these utility scores were used to create a sensitivity analysis based on stone clearance rate.

Results

Laparoscopic cholecystectomy with intraoperative endoscopic retrograde cholangiopancreatography had a utility score of 0.9910, a stone clearance rate of 95.5%, a morbidity of 6.3%, and a mortality of 0.2%. Preoperative endoscopic retrograde cholangiopancreatography with laparoscopic cholecystectomy had a utility score of 0.9629, a stone clearance rate of 85.5%, a morbidity of 13.3%, and a mortality of 0.8%. Laparoscopic cholecystectomy with common bile duct exploration had a utility score of 0.9882, a stone clearance rate of 88.3%, a morbidity of 12.9%, and a mortality of 0.3%.

Conclusion

We have shown that a laparoscopic cholecystectomy with an intraoperative endoscopic retrograde cholangiopancreatography is associated with the best overall outcomes.

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Authors and Affiliations

  1. Division of Gastrointestinal Surgery, University of South Florida Morsani College of Medicine, Five Tampa General Circle 740, Tampa, FL, 33606, USA

    Obada Kattih & Vic Velanovich

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Contributions

Obada Kattih and Vic Velanovich made substantial contributions to the conception and study design of the work, acquisition, analysis, and interpretation of the data for the work; drafting the work and revising it critically for important intellectual content; final approval of the version to be published; and agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy and integrity of any part of the work are appropriately investigated and resolved.

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Correspondence to Vic Velanovich.

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Obada Kattih has no conflicts of interest. Vic Velanovich is a speaker for Integra LifeSciences and a paid consultant for Innocoll Pharmaceuticals.

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Presented at: Digestive disease Week, May 23rd, 2022, San Diego, CA.

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Kattih, O., Velanovich, V. Comparing One-Stage vs Two-Stage Approaches for the Management of Choledocholithiasis. J Gastrointest Surg 27, 534–543 (2023). https://doi.org/10.1007/s11605-022-05458-y

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