A Prospective Study on Endoscopic Stone Extraction followed by Laparoscopic Cholecystectomy under Same Anaesthesia

Abstract

Background: The ideal management of common bile duct (CBD) stones associated with gall stones is a matter of debate. The best outcome in addressing simultaneous cholelithiasis (gallstone disease [GSD]) and choledocholithiasis is single-session endoscopic stone extraction (ESE) with laparoscopic cholecystectomy (LC) (common bile duct stone [CBDS]). Traditional rendezvous with an intraoperative cholangiogram is accompanied with a number of technical (bowel distention, frozen Calot's triangle, intraoperative cholangiogram restriction, and so on) and logistical challenges (lack of trained personnel and equipment for ESE in the operating room). To examine the safety of the technique and solve the disadvantages of the conventional rendezvous strategy, we adapted our ESE-LC approach (tandem ESE-LC).

Methods:A prospective study of individuals with GSD and suspected CBDS was undertaken in SIMS Hospital, Vadapalni Chennai, from 2017 to 2019. Tandem ESE-LC entails performing ESE and LC on the same day under the same general anaesthetic, with ESE conducted in the endoscopic suite using carbon dioxide insufflation, bile duct clearing achieved using a balloon/basket, and the procedure validated by an occlusion cholangiogram. After that, patients were sent to the operating room for LC. The procedure's primary result was bile duct clearing, as well as the procedure's safety.

Results: The research comprised 84 patients out of 112 who were examined for eligibility (median age: 52 years). The most prevalent presenting symptom was biliary colic (n = 48), followed by acute cholecystitis (n = 22). The median stone size and number of stones were 1 (1–6) and 4 mm (3–10), respectively. The bile ducts were cleared in all of the patients. In 10 patients, stenting was performed. Calot's dissection was difficult and frozen in 20 and 22 patients, respectively, during surgery. In 26 of the patients, the cystic duct was short and broad. In 12 of the patients, a subtotal cholecystectomy was done. The average length of stay in the hospital after surgery was 1 (0–12) days. On a day-care basis, three patients received tandem ESE-LC. One patient required percutaneous drainage for gall bladder fossa collection after endoscopic retrograde cholangiopancretography, and another required percutaneous drainage for post–endoscopic retrograde cholangiopancretography pancreatitis. After a median of 17 (3–28)months of follow-up, no patient had retained CBDS.

Conclusion: Tandem ESE-LC is a safe and successful approach for treating GSD and CBDS in the same patient.