[Comparison of combined (endoscopic sphincterotomy + laparoscopic cholecystectomy) and classical treatment of obstructive jaundice in the course of cholelithiasis]

Abstract

Since August 1993 till December 1996, 672 patients with the gallstone disease were submitted to the laparoscopic cholecystectomy (LC). In 78 (11.7%) of them, the endoscopic sphincterotomy (ES) was performed before LC for the treatment of the coexistent obstructive jaundice caused by bile duct stones (Group I). ES was successful in 70 patients (90%). The laparoscopic cholecystectomy was done after the bilirubinemia reached the level within the normal ranges. This period (4 days to 35 days) was dependent on the level of hyperbilirubinemia at presentation. In 12 cases both procedures were performed at the same time. LC was successful in 67 patients (96%). The mean period between ES and LC was 2.7 days. The mean time of hospital stay was 6.3 days. In other 52 patients open cholecystectomy with T drainage was done for the treatment of the gall stone disease complicated by the obstructive jaundice (Group II). Comparing the two group of patients, the significantly shorter time of treatment and hospital stay as well as the lower incidence of complications was observed in Group I.

Conclusion: ES and LC in patients with the obstructive jaundice caused by stones results in lower morbidity and shorter time of treatment when comparing with patients treated by classical open cholecystectomy with T drainage.