Comparison of Intraoperative ERCP vs Laparoscopic Common Bile Duct Exploration for CBD Stones in an Under-resourced Setting

• Published in: Indian journal of surgery 2024, Vol.86 (5), p.938-943
• Main Authors: Garza, Alberto Riojas, Rodriguez, H. Alejandro, Guajardo Nieto, Diego A., Treviño Figueroa, Adriana M., Urquijo, Mauricio González, Macías, Mario Enrique Rendón, Gidi, Ale Alam Gibran, Muñiz, José J., Shade, Mario Rodarte
• Format: Article
• Language: English
• Subjects: Bile ducts; Cardiac Surgery; Endoscopy; Laparoscopy; Medicine; Medicine & Public Health; Neurosurgery; Original Article; Pediatric Surgery; Plastic Surgery; Surgery; Thoracic Surgery
• ISSN: 0972-2068; 0973-9793
• DOI: 10.1007/s12262-023-03997-5

Intraoperative endoscopic retrograde cholangiopancreatography (IO-ERCP) and laparoscopic common bile duct exploration (LCBDE) are minimally invasive procedures used to extract common bile duct (CBD) stones and perform cholecystectomy in a single stage. There is no consensus as to which is the ideal method for CBD stone treatment and decisions are made based on surgeons’ preference and hospital protocols. Evidence in emergency and resource-constrained settings (where choledochoscopes may be unavailable) is limited. The objective of this study was to compare CBD clearance rates, intraoperative time, in-hospital stay (IHS) length, retained stones, and complications between IO-ERCP and LCBDE in patients with CBD stones in emergency settings at a lower-income health center. An observational ambispective cohort study was conducted in patients with acute abdominal pain diagnosed with CBD stones and treated with IO-ERCP or LCBDE at Hospital Metropolitano, Monterrey, Mexico, during a 3-year period. Seventy-four patients were analyzed (39 IO-ERCP, 35 LCBDE). CBD clearance, procedure time, and retained stones between IO-ERCP and LCBDE were not statistically different (79% vs 62%, p = 0.12; 205 vs 193 min, p = 0.95; five IO-ERCP and two LCBDE cases, p = 0.26). IO-ERCP had shorter IHS length (1 vs 2 days, p = 002). Postoperative complications were more common in IO-ERCP (5 vs 0 cases, p = 0.036). Intraoperative endoscopic retrograde cholangiopancreatography had similar common bile duct clearance and retained stone rates compared to laparoscopic common bile duct exploration in emergency settings at a resource-constrained health center. IO-ERCP had a higher complication rate, yet with low impact on in-hospital stay length.