One-Stage Laparo-Endoscopic Treatment of Cholecysto-Choledocholithiasis

Abstract Introduction: Despite advances in both endoscopic and surgical therapeutics, the management of cholecysto-choledocholithiasis continues to present a dilemma to both surgeons and gastroenterologists as a consensus on optimal management does not yet exist. Patients and Methods: Patients with gallbladder stones and confirmed concomitant Common Bile Duct Stones (CBDS) were submitted to one-stage Laparoscopic Cholecystectomy (LC), Endoscopic Retrograde Cholangiography (ERC), endo-scopic sphincterotomy and clearance of CBDS during the period from January 2009 to January 2017. Results: The study included 200 patients with a median age of 45.3 years. Pre-operative work up confirmed the presence of CBDS in all patients. Five patients (2.5%) were converted to open surgery. Intra-Operative Cholangiography (IOC) was performed in 185 patients (94.9%) and it showed CBDS in 175 of them (94.6%). Ten patients (5%) with no stones on IOC had LC only. In 185 patients (92.5%), LC plus ERC and endoscopic clearance of CBDS were completed successfully. The median total procedural time was 104 minutes and the median post-operative (PO) hospital stay was 1.5 days. Two patients (1.1%) developed post-ERC bleeding. Liver function tests were normalized in all patients within 3 weeks PO. It was possible to re-assess all patients at 1 month and 160 patients (86.5%) at 6 moths PO and all were symptom-free with no evidence of recurrent CBDS. There was no mortality. Conclusion: One-stage laparo-endoscopic treatment of cholecysto-choledocholithiasis is safe and effective with a short total procedural time and a short hospital stay.