| Title: |
Sequential endoscopic and laparoscopic treatment for choledocholithiasis: a 30-year experience in the era of evolving techniques |
| Authors: |
Delcarro A.; Cesana G.; Ciccarese F.; Uccelli M.; Zanoni A. A. G.; Giorgi R.; Oldani A.; Rubicondo C.; Bonaldi M.; Lee Y.; Moioli D.; Olmi S. |
| Contributors: |
Delcarro, A.; Cesana, G.; Ciccarese, F.; Uccelli, M.; Zanoni, A. A. G.; Giorgi, R.; Oldani, A.; Rubicondo, C.; Bonaldi, M.; Lee, Y.; Moioli, D.; Olmi, S. |
| Publisher Information: |
Springer |
| Publication Year: |
2026 |
| Subject Terms: |
Common bile duct stone; Endoscopic treatment; Laparoscopic cholecystectomy; Laparoscopy; Sequential therapy; Sphincterotomy |
| Description: |
Background: Sequential endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy (EST) followed by laparoscopic cholecystectomy (LC) is a standard minimally invasive approach for treating concomitant gallbladder and common bile duct stones. This study presents a 30-year experience with this strategy and compares its outcomes with emerging single-session techniques, including laparoscopic common bile duct exploration (LCBDE) and laparoendoscopic rendezvous (LERV). Methods: Between October 1991 and December 2020, a total of 350 patients (mean age 65years, range 35–80) underwent EST and/or ERCP followed by LC in a sequential treatment protocol for choledocholithiasis. Patient demographics, intra- and post-procedural variables, complication rates, and long-term outcomes were retrospectively reviewed. The success rate of stone clearance, morbidity, mortality, and recurrence rates were calculated. Results: Of the 350 treated patients, 240 (68.6%) had confirmed CBD stones. ERCP/EST achieved stone clearance in a single-session in 180 patients (75%). Among the remaining cases, additional ERCP sessions were required, and 14 patients ultimately failed to achieve endoscopic clearance. Three patients discontinued treatment (two declined a second ERCP and one refused LC after endoscopic clearance). Laparoscopic cholecystectomy was aborted in three patients (one due to anesthetic intolerance and two due to severe inflammation). Post-procedural complications occurred in 21 patients (6%), predominantly comprising mild pancreatitis and minor bile leak, or wound infections. No mortality was observed. Median hospital stay was 5.5days. Recurrent CBD stones were observed in 15 patients (4.3%), managed with repeat ERCP (8 cases) or surgical revision (7 cases). Conclusions: While sequential therapy remains an effective and widely adopted technique, the growing body of evidence on single-session, minimally invasive strategies such as LCBDE and LERV offers valuable alternatives in selected scenarios. Each approach ... |
| Document Type: |
article in journal/newspaper |
| Language: |
English |
| Relation: |
info:eu-repo/semantics/altIdentifier/pmid/41136653; info:eu-repo/semantics/altIdentifier/wos/WOS:001599468100001; volume:40; firstpage:475; lastpage:479; journal:SURGICAL ENDOSCOPY; https://hdl.handle.net/20.500.11768/191917 |
| DOI: |
10.1007/s00464-025-12338-4 |
| Availability: |
https://hdl.handle.net/20.500.11768/191917; https://doi.org/10.1007/s00464-025-12338-4 |
| Accession Number: |
edsbas.6A88648 |
| Database: |
BASE |