Authors' objectives:

The usefulness of laparoscopy in the management of biliary stones in the common bile duct was evaluated, especially LECBD compared to standard endoscopic techniques.

Authors' results and conclusions: For this report a consensus on digestive endoscopy of the U.S National Health Institutes, 3 narrative revisions, three controlled randomized clinical trials, and 15 case-series and retrospective cohorts were used. In addition a position statement issued by the U.S. Society of Gastrointestinal Surgeons and Endoscopists was chosen.The main evidence is based on clinical trials with methodological limitations (level IB), and there is not enough information to date to definitely support the choice of one or other therapeutic method.The mortality for both techniques seems to be similar, about 1-1.5%. The effectiveness of LECBD is over 90% in most reports, and it is similar to that of ERCP with sphinterotomy. The short term complications of this endoscopy (ERCP) are about 8% and are related with the procedure (pancreatitis, perforation, bleeding). At middle term, almost 8% present colangitis and recurrent bile duct lithiasis. The long term complications are exceptional. ERCP performed together with laparoscopic cholecystectomy, pre or post surgery has a rate of complications of about 13%. The complications of LECBD include residual stones (5%), need for an open surgery (4%), and residual stenosis (3%). The procedure together with laparoscopic cholecystectomy at the same time leads to a complication rate of 11%, but it can reach 18% depending on the center. In young patients the results are better. The disadvantages of the method include the need to have highly trained surgeons, and the availability of equipment for its performance.

Authors' recommendations: ERCP and LECBD are alternative therapeutic methods for the treatment of common bile duct stones, bearing in mind that the surgeon s capacity is a limiting variable for LECBD. Both techniques are equally effective and relatively safe. For both methods the effectiveness reported is near 90%, with approximately 1% mortality.There are many potential advantages of LECBD as regards short and long term complications, as well as a shorter hospital stay, but there is no certain information in the literature to support this fact.It is worth pointing out that the literature about LECBD comes from highly specialized centers in the field, comparable only to few centers in our country. The use of LECBD will depend on the possibility of the patients to undergo a long procedure, the age; the ability and skill of the surgeon, the availability of sophisticated equipment and the preferences of each center and the experience in LECBD. In addition some factors such as the anatomy of the cystic duct, number, size and position of the stones in the bile ducts and the existence of common bile duct dilation.For the reasons already mentioned, LECBD could be performed in selected centers, ideally within a research protocol framework in order to obtain more information about its effectiveness.

Authors' methods: Overview

Project Status: Completed

URL for project: http://www.iecs.org.ar/

Year Published: 2005

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Argentina

Organisation Name: Institute for Clinical Effectiveness and Health Policy

Contact Address: Dr. Emilio Ravignani 2024, Buenos Aires - Argentina, C1414 CABA

Contact Name: info@iecs.org.ar

Contact Email: info@iecs.org.ar

Copyright: Institute for Clinical Effectiveness and Health Policy (IECS)