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KMID : 0978820070100020073
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Journal of the Korean Society of Endoscopic & Laparoscopic Surgeons
2007 Volume.10 No. 2 p.73 ~ p.78
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Comparative Study of Laparoscopic Common Duct Exploration and Cholecystectomy versus Endoscopic Stone Extraction and Laparoscopic Cholecystectomy for Gallbladder- common Duct Stones
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Ahn Sang-Hoon
Jang Jin-Young
Lee Seung-Eun
Hwang Dae-Wook
Ahn Young-Joon
Kim Sun-Whe
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Abstract
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Purpose: There is no consensus about treatment guidelines and the clinical superiority of laparoscopic common duct exploration (LCDE) plus cholecystectomy versus endoscopic stone extraction plus laparoscopic cholecystectomy (LC) for gallbladder-common duct (GB-CD) stones. The purpose of this study is to compare the clinical outcome and medical costs between the two treatment options in the management of GB-CD stones under current Korean socio-medical circumstances.
Methods: From January 2000 to July 2005, patients with GB-CD stones that underwent either LCDE plus LC (LCDE group, n=29) or an endoscopic sphincterotomy (EST) plus LC (ESTLC group, n=64) were retrospectively reviewed. Among the ESTLC group patients, 18 patients were excluded due to endoscopic treatment failure (ERC group, n=46). The CD stone size, CD diameter, various clinical parameters, the length of hospital stay, treatment durations, complications and overall hospital costs were analyzed.
Results: There were no significant differences in preoperative clinical parameters (such as age, sex and, comorbidity), CD size (14.92 mm vs. 14.52 mm), CD stone size (7.55 mm vs. 7.74 mm), CD stone number (1.45 vs. 1.74) as well as the hospital stay length (13.4 days vs. 12.0 days), retained stone rate (10.3% vs. 6.5%), and complication rate (13.8% vs. 17.4%) between the LCDE and ESTLC groups. The overall treatment duration was significantly shorter in the LCDE group of patients (31.9 days vs. 62.7 days, p=0.044). Group LCDE patients had significantly decreased hospital costs (3.4 million Korean won vs. 4.3 million Korean won, p=0.049). There were no recurrent stone cases for group LCDE patients; four recurrent stone cases occurred in group ERC patients.
Conclusion: Two treatment options for GB-CD stones are comparable with respect to clinical results including complications, the retained stone rate and recurrent stone rate. LCDE management is associated with significantly decreased overall treatment duration and overall hospital costs. LCDE plus LC for GB-CD stones is an excellent treatment option considering current Korean socio-medical circumstances.
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KEYWORD
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Laparoscopic surgery, CD stone, EST, LCDE
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