Role of open choledochotomy in the treatment of choledocholithiasis

In recent years, several less invasive procedures have challenged the preeminence of open choledochotomy in the management of patients with choledocholithiasis. Alternatives now include endoscopic sphincterotomy, extracorporeal shock-wave lithotripsy, percutaneous transhepatic stone extraction, and...

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Bibliographic Details
Published inThe American journal of surgery Vol. 165; no. 4; pp. 483 - 486
Main Author Pitt, Henry A.
Format Journal Article Conference Proceeding
LanguageEnglish
Published New York, NY Elsevier Inc 01.04.1993
Elsevier
Elsevier Limited
Subjects
Algorithms
Biological and medical sciences
Cholangitis
Cholecystectomy
Clinical trials
Common Bile Duct - surgery
Endoscopy
Gallbladder
Gallstones - mortality
Gallstones - surgery
Gastroenterology. Liver. Pancreas. Abdomen
Humans
Laparoscopy
Lithotripsy
Liver. Biliary tract. Portal circulation. Exocrine pancreas
Medical sciences
Morbidity
Other diseases. Semiology
Patients
Retrospective Studies
Sphincterotomy, Endoscopic
Stone
Treatment Outcome
United States
United States
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Summary:In recent years, several less invasive procedures have challenged the preeminence of open choledochotomy in the management of patients with choledocholithiasis. Alternatives now include endoscopic sphincterotomy, extracorporeal shock-wave lithotripsy, percutaneous transhepatic stone extraction, and laparoscopic common duct exploration. In deciding whether an alternative is appropriate for an individual patient, factors to consider include the following: (1) the presence or absence of the gallbladder; (2) the severity of the presenting symptoms; (3) the results of open choledochotomy; and (4) local endoscopic, radiologic, and laparoscopic expertise. Review of available data suggests that endoscopic spincteroplasty is appropriate for older patients without a gallbladder and for those with severe toxic cholangitis. However, endoscopic sphincterotomy has not been proven to be worth-while before open surgery. Open choledochotomy has been reported to have a mortality rate of less than 2%, leaving fewer than 5% of patients with retained stones. Since the introduction of laparoscopic cholecystectomy, treatment algorithms for patients with common duct stones have seldom included open choledochotomy. However, future prospective, randomized trials of the management of patients with choledocholithiasis should include open choledochotomy as the gold standard.
ISSN:0002-9610
1879-1883
DOI:10.1016/S0002-9610(05)80946-8