PREOPERATIVE THERAPEUTIC SPLITTING IN GAL LSTONE SURGERY

Introduction: The best clinical strategy for using ERC combined with L C is still unknown. Based on a wide discussion of literature reports t he aim of our study is to critically analyse laparoscopic bile duct ex ploration and to correlate these data to our prospective study of ''th erapeutical splitting''. Patients and Methods: In a prospective study 1645 consecutive patients with sympomatic gall stone disease were exam ined by ultrasound. 309 patients had open cholecystectomy because of p revious gastric surgery or perforation. Patients with a high probabili ty of harbouring stones in the common duct or having other related dis orders like biliary pancreatitis had ERC, EPT and stone extraction. 13 36 patients had attempted LC. Results: At endoscopy 70% of the 260 pat ients required therapy like EPT and/or stone extraction, 95% consequen tly had their gallbladder removed laparoscopically. Including the pati ents with biliary pancreatitis morbidity amounted to 3% with no mortal ity. In the non-endoscopic group with 1076 patients conversion was 6.8 %, morbidity was 4.3% and mortality 0.09%. Residual stones were found in 0.5% so far. Conclusion: If selection criteria for bile duct pathol ogy have a high sensitivity and specificity and endoscopical stone cle arance rate is high,at present ''therapeutical splitting'' still is th e method of choice.