Comparison of open, laparo-endoscopic and one-stage laparoscopic approaches for treatment of gallbladder and common bile duct stones

INTRODUCTION: The aim of this study was to compare the results of 3 treatment methods for common bile duct (CBD) and gallbladder stones: open, 2-stage endoscopic-laparoscopic, and 1-stage laparoscopic CBD exploration.

METHODS: A total of 229 patients with a median age of 59 years (range: 9–92 years) were enrolled in this study. All of the patients had symptomatic gallbladder stone or CBD stones, which were found preoperatively or intraoperatively using ultrasonography, magnetic resonance-cholangiography, intraoperative contrast cholangiography, or fiberoptic choledochoscopy. Three methods of management of patients were employed. The classic open approach, which consists of laparotomy, cholecystectomy, and CBD exploration was used in 78 patients. The 2-stage laparo-endoscopic approach, which includes pre- or postoperative endoscopic retrograde cholangiopancreatography and laparoscopic cholecystectomy, was performed in 84 patients. One-stage laparoscopic management consists of laparoscopic cholecystectomy and CBD exploration with intraoperative cholangiography and fiberoptic choledochoscopy, and was performed in 67 patients.

RESULTS: Operation time in open, laparo-endoscopic and one-stage laparoscopic patients was 121 min, 142 min and 123 min, respectively. Stone removal rate were comparable between three groups - 94.8%, 85.7% and 97 % for open, laparo-endoscopic and one-stage laparoscopic patients, respectively. Hospital stay was significantly shorter in one-stage laparoscopic group (2.3 days in one-stage laparoscopic, 6.5 days in laparo-endoscopic and 8.2 days in open). Significant difference was found in complication rate. Total number of complications (19.4%) in one-stage laparoscopic group was significantly (p<0.05) lower than open (52.5%) and laparo-endoscopic (33.3%) groups. Most of complications (92.5%) in one-stage laparoscopic group were minor and did not require interventions.
DISCUSSION AND CONCLUSION: In comparison with the open and 2-stage laparo-endoscopic approaches, 1-stage laparoscopic cholecystectomy and CBD exploration have advantages, including shorter operative time, shorter hospital stay, lower complication rate, and greater stone removal rate, and may be considered the first choice for treatment of gallbladder and CBD stones.