Laparoscopic Treatment of Common Bile Duct Stones : What Are the Limits and When Should we Call the Endoscopist ?

Study Overview
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Brief Summary
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The aim of this study was to identify some risk factors of failure of surgical management of common bile duct stones, in our center between 2007 and 2019.

Detailed Description
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Lithiasis disease represents a real public health problem. Indeed, 10% of the general population is asymptomatic carrier of gallbladder stones and among them, 35% will present a symptomatic form which will cause the indication of cholecystectomy. As a result, around 120,000 cholecystectomies are performed per year in France, and around 750,000 in the United States for this indication. Cholecystectomy is therefore the most widely performed procedure in the world. However, in 3 to 20% of cases, common bile duct stones will be associated and to be treated. Different strategies are proposed: a treatment called all surgical or an endoscopic treatment (usually a sphincterotomy) before, after or during a cholecystectomy. The investigators defined two groups of patients: one group with success of fully laparoscopic surgical treatment (cholecystectomy and laparoscopic exploration of the common bile duct at the same time), and one group treated by laparoscopic cholecystectomy and management of the common bile duct stone(s) by an ERCP performed intra, per ou postoperatively. The primary outcome was the failure of surgical management, defined as the requirement of ERCP for extraction of common bile duct stones, which permit us to identify risk factors of failure in the fullfil surgical treatment process. The secondary outcome was to study the morbimortality in each group, and length of stay.

Official Title
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Treatment of Common Bile Duct Stones in a Laparoscopic Center : What Are the Limits and When Should we Call the Endoscopist ? Observationnal Study Between 2007-2019

Conditions
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Laparoscopic, Common Bile Duct Stone With Chronic Cholecystitis

Intervention / Treatment
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* Procedure: Laparoscopic common bile duct exploration.


Participation Criteria
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Eligibility Criteria
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Inclusion criteria: More than 18 years old Between 2007 and 2019 Montpellier University Hospital Laparoscopic cholecystectomy for symptomatic cholelithiasis associated to common bile duct stones Common bile duct stones highlighted on preoperative imaging or intraoperative cholangiography Common bile duct stones treated during the same hospital stay surgically or endocopically Exclusion criteria: Laparotomy Previous ERCP Less than 18 years old Lost to follow up Lack of data > 10% Other surgical procedure associated at the same time Previous cholecystectomy Caroli's disease Severe cholangitis or acute pancreatitis Pigmentary or hydatic lithiasis Laparoscopic cholecystectomy for other indication than symptomatic cholelithiasis

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Success of LCBDE<br>Patients with a fully laparoscopic surgical treatment of common bile duct stones | Procedure: Laparoscopic common bile duct exploration.<br>* Laparoscopic common bile duct exploration. ERCP (Endoscopic Retrograde Cholangiopancreatography) with sphincterotomy : : removal of common bile duct stones trought the cystic duct (transcystically) with a Dormia or a choledoscope, or throught the common bile duct with a choledoscope introduced throught an incision of the common bile duct. ERCP with sphincterotomy: removal of common bile duct stones throught the duodenal papilla, and a sphincterotomy of the oddi sphincter during the same time.<br>|
| Failure of LCBDE<br>Patients with a laparoscopic cholecystectomy but an endoscopic treatment of common bile duct stone with an ERCP performed intra, per or postoperatively | Procedure: Laparoscopic common bile duct exploration.<br>* Laparoscopic common bile duct exploration. ERCP (Endoscopic Retrograde Cholangiopancreatography) with sphincterotomy : : removal of common bile duct stones trought the cystic duct (transcystically) with a Dormia or a choledoscope, or throught the common bile duct with a choledoscope introduced throught an incision of the common bile duct. ERCP with sphincterotomy: removal of common bile duct stones throught the duodenal papilla, and a sphincterotomy of the oddi sphincter during the same time.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| morbimortality | Clavien dindo classification | 1 day | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| risk factors of total laprascopic treatment failure. | risk factors of total laprascopic treatment failure. | 1 day | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Common bile duct stones, Laparoscopic common bile duct exploration (LCBDE), ERCP, Morbimortality