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- W2709157002 abstract "The rapid expansion of laparoscopic cholecystectomy has led to debate regarding the optimal method of dealing with concomitant stones in the common bile duct (CBD), particularly in younger patients. The choice lies between four techniques. ERCP and sphincterotomy is the endoscopic treatment of choice and should result in a complication rate of 5% or less with similar long term morbidity to open BVD operation. Endoscopic balloon dilation of the papilla is a technique which shows much promise but requires further evaluation in randomised trials. Open surgical exploration of the CBD was the treatment of choice prior to the advent of endoscopic sphincterotomy. However, it is now less frequently performed due to the edvent of laparoscopic techniques. Laparoscopic CBD exploration (LCBDE) is effective in over 90% of selected cases but is not widely available. Initial studies suggest that LCBDE and sphincterotomy have comparable efficacy and morbidity but as sphincterotomy is much more widely available it will probably remain the treatment of choice in many centres. Patients requiring a cholecystectomy should only undergo a pre-operative ERCP if they fulfil strict criteria which have been shown to reduce the frequency of unnecessary procedures. Any CBD stones can be removed by sphincterotomy before proceeding to laparoscopic cholecystectomy. Those whose intra-operative cholangiogram shows a CBD stone should have a post-operative ERCP or alternatively LCBDE in centres where sufficient expertise exists. Time will tell if LCBDE can surpass the standards currently being set by endoscopic sphincterotomy." @default.
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- W2709157002 title "Operative treatment is no safer than endoscopic sphincterotomy in the young patient with bile duct stones" @default.
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