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A Journal on Surgery
Indexed/Abstracted in: EMBASE, Scopus, Emerging Sources Citation Index
Chirurgia 1999 October;12(5):327-32
Evolution of cholecystocholedocholithiasis treatment in Piemonte between 1992 and 1997
Guglielminotti P., Brachet Contul R., Giraudo G., Morino M.
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Background. Evaluation of current management of cholecystocholedocholithiasis in an homogeneous area.
Methods. In 1997 in Piedmont among 4601 cholecystectomies, 553(12%) patients with gallbladder and common bile duct stones were treated in 35 Surgical Departments. Common bile duct stones were diagnosed preoperatively in 435 patients (1st group, 79%), intraoperatively in 118 cases (2nd group, 21%).
Results. In the first group, endoscopic retrograde cholangio-pancreatography (ERCP) with endoscopic sphincterotomy (ES) followed by laparoscopic cholecystectomy (LC) was the treatment of choice for 355 (77%) patients. Eighty-five (20%) patients were treated by complete open surgery; only 6 (1%) were treated by one-stage laparoscopy, either by a transcystic approach or by laparoscopic choledochotomy. The endo-laparoscopic technique was performed in 9 (2%) cases. In the second group, 78 (66%) patients were treated by laparotomic approach; mini-invasive approaches were applied in 40 (34%) patients.
Conclusions. Sequential minimal invasive treatment and open surgery are the standard approaches to preoperative and intraoperative diagnosed cholecystocholedocholithiasis. One-stage management of common bile duct stones, either laparoscopic or endoscopic-laparoscopic, is at present confined to advanced laparoscopic surgical Departments.