World Journal of Laparoscopic Surgery

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VOLUME 2 , ISSUE 3 ( September-December, 2009 ) > List of Articles

REVIEW ARTICLE

Practical Considerations for Common Duct Stone Clearance

Dennis L Sta Ana

Citation Information : Ana DL. Practical Considerations for Common Duct Stone Clearance. World J Lap Surg 2009; 2 (3):11-14.

DOI: 10.5005/jp-journals-10007-1029

Published Online: 01-12-2009

Copyright Statement:  Copyright © 2009; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Patients undergoing cholecystectomy have a 10 to 18% chance of common duct stone (CDS) being discovered during the procedure. With the advent of laparoscopy the generally successful open common bile duct exploration for the treatment of common duct stone has been largely replaced by endoscopic means. Lately however, endoscopic clearance is being challenged by a single stage laparoscopic common duct exploration. No clear consensus has been developed to delineate specific practice guidelines for each procedure. Even so, different variables such as patient variables, institutional limitations and technical considerations make the choice of the appropriate procedure a lot more confusing. It is the aim of this article review to find out practical options for the surgeons on the basis of established parameters for safe surgery as well circumstantial parameters that may be variably present in different hospital settings. The search strategy was to review literatures, abstracts, electronic databases, and bibliographies published from year 1999 until 2008 using different medical search engines. Results of this review showed two RCTs (n 378) comparing preoperative endoscopic clearance vs laparoscopic stone clearance and two smaller RCTs (n 166) which compared single stage laparoscopic stone clearance vs delayed endoscopic clearance. There was shorter length of stay in the laparoscopy arm in both studies but stone clearance rate, mortality and morbidity were not significantly different for all studies. Literatures that dealt with circumstantial parameters such as patient variables, institutional limitations and technical expertise, all showed positive significance for these parameters in predicting the success or failure of a procedure for common duct clearance.


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