M. Trias et al., PROSPECTIVE EVALUATION OF A MINIMALLY INVASIVE APPROACH FOR TREATMENTOF BILE-DUCT CALCULI IN THE HIGH-RISK PATIENT, Surgical endoscopy, 11(6), 1997, pp. 632-635
Background: The best approach to bile duct stones in highrisk patients
is controversial. We showed in a randomized trial that open surgery h
ad a morbi-mortality similar to that of endoscopic sphincterotomy alon
e (ES) and less late biliary complications. The aim of this study was
to evaluate a minimally invasive approach to duct stones in high-risk
patients compared with open surgery or ES alone. Methods: Sixty high-r
isk patients (mean age 80 years) suspected of duct stones were treated
by ES + laparoscopic cholecystectomy (LC). High-risk factors were: ag
e > 70 years, Goldman cardiac index > 13, chronic pulmonary disease, l
iver cirrhosis, neurologic deficit, and severe obesity. Results: ERCP
success was 87%. Duct stones were found in 75%. LC succeeded in 92%. P
ost-LC stay was 4 days. Overall morbidity was 19% and mortality was 3%
. Recurrent symptoms (mean follow-up: 9 months) was 3.6%. When compare
d with open surgery or ES alone, ES + LC had a similar morbi-mortality
, but shorter postop stay (p < 0.001). Late symptoms appeared in 20% a
fter ES alone vs 4% after open surgery or ES plus LC (p < 0.04). Concl
usions: Combined ES + LC is an effective alternative to open surgery o
r ES alone for treatment of duct stones in high-risk patients.