Intraoperative Endoscopic Sphincterotomy is a Reasonable Option for Complete Single-Stage Minimally Invasive Biliary Stones Treatment: Short-Term Experience with 57 Patients

Background and Study Aims: How to approach common bile-duct (CBD) stones discovered during laparoscopic cholecystectomy (LC) is still a subject for debate. After sequential strategies, the natural trend is now towards single-stage therapy. The aim of this study was to establish the feasibility of intraoperative endoscopic sphincterotomy (IOES) when CBD stones are discovered or strongly suspected on intraoperative cholangiography (IOC) during LC.

Patients and Methods: Out of a total of 2193 laparoscopic cholecystectomies, we reviewed 57 patients who, between 1991 and 1999, underwent IOES just after LC during the same anesthetic session. Under fluoroscopic guidance, one group of 32 patients (Dijon) underwent IOES in the prone position and a second group of 25 patients (Poitiers) in the left lateral position.

Results: IOES was successful in all cases (100 %). CBD stones were definitively found in 49 cases (86 %) but retrieved or released into the duodenum after IOES in only 46 cases (46/49, 93.9 %). The mean duration of the intraoperative endoscopic procedure was 28 minutes (range 15 - 75). The short-term complication rate was 7 %. The mean postoperative hospital stay was 5.3 days (range 2 - 14).

Conclusions: IOES performed after LC during the same anesthetic session is feasible with low risk and with good results. It offers the opportunity to treat in one stage both cholecystolithiasis and choledocholithiasis without the need for surgical CBD exploration.

Abstract in French

La sphinctérotomie endoscopique per-opératoire, une option raisonnable pour un traitement en un seul temps de la maladie lithiasique vésiculaire et choledocienne: résultats à court-terme d'une série de 57 patients.

Objectif: à 1'ère de la cholecystectomie per-coelioscopique, alors que le débat sur les modalités techniques du traitement du (ou de) calcul(s) de la voie biliaire principale (VBP) intéressant de livrer l'expérience de deux centres pratiquant la sphinctérotomie endoscopique per-opératoire (SEPO) pour des calculs de la VBP découverts lors de la cholangiographie per-opératoire.

Patients: sur un total de 2193 cholecystectomies laparoscopiques (CL) réalisées de 1991 à 1999, nous avons revu une série de 57 patients qui ont bénéficié SEPO immédiatement après une CL au cours de la même séance anesthésique. Grâce un amplificateur de brillance, un groupe de 32 patients a bénéficié d'une SEPO en décubitus vental (Dijon) et un autre groupe de 25 patients dans la position latérale gauche (Poitiers).

Résultats: la SEPO a été réussie dans tous les cas (100%). Un ou plusieurs calculs ne furent finalement retrouvés que dans 49 cas (86%) et extraits ou libérés dans le duodénum dans 46 cas (46/49, 93%). La durée moyenne de l'intervention endoscopique a été de 28 minutes (extrêmes 15–75). Le taux de complications à court terme a été de 7.01%. La durée moyenne du séjour post-opératoire a été de 5.3 jours (extrêmes 2–14).

Conclusion: la SEPO effectuée juste après la CL dans le même temps anesthésique est réalisable techniquement avec de bons résultats. Elle offre la possibilité de traiter en un seul temps opératoire la maladie lithiasique vésiculaire et cholédochocienne sans la nécessité d'une exploration chirurgicale de la VBP.

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