POSTCHOLECYSTECTOMY CHOLEDOCHOLITHIASIS - REAL EFFICACY OF ENDOSCOPICSPHINCTEROTOMY

Aim: To assess real efficacy of endoscopic sphincterotomy in the setti ng of postcholecistectomy choledocolitiasis (i.e., without excluding f or analysis any patient referred for the procedures) traditionally the evaluation has been done after excluding those cases in which the pro cedure failed or was not attempted. Design: Retrospective analysis of a series of cholecystectomized patients with choledocolithiasis. Patie nts were included for analysis on an <<intention to treat>> basis, wit hout excluding cases in which the procedure either was not attempted o r failed. Results: Out of 122 patients (47.1%) with a firm diagnosis o f choledocholithiasis, endoscopic sphincterotomy was performed in 108 (88.5%); in the remaining 13 (10.7%), it was not attempted due to vari ous reasons (among other, five cases of unsuccessful diagnostic cholan giography). In one patient, with a previous surgical sphincteroplasty, calculi were directly extracted. On the whole, stone extraction/expul sion was archieved in 92 cases (including the one patient with previou s surgical sphincteroplasty), what represents a success rate of 75.4% on 122 cholecistectomized patients with known choledocolitiasis. Morbi dity and mortality reached 9% and 1%, respectively. Conclusions: If ea ch referred patient is included for analysis of the results of endosco pic sphincterotomy for postcholecistectomy choledocolithiasis (indepen dently of technical success), the therapeutic yield of this procedure lowers significantly compared with the usual estimations.