LAPAROSCOPIC APPROACH OF THE MAIN BILE DUCT IN TREATMENT OF CHOLEDOCHOLITHIASIS. EXPERIENCE OF A BILIO-PANCREATIC UNIT

The aim is to analyze the validity and safety of a new program of laparoscopic common bile duct exploration (LCBE) in the treatment of choledocholithiasis (CD), evaluating hospital stay and cost-effectiveness. MATERIAL AND METHODS Today, there is controversy over which is the best therapeutic option in choledocholithiasis: preoperative ERCP followed by laparoscopic cholecystectomy (LC) versus LCBE. We designed this prospective, non-randomized, single-center study with 118 patients (67 women and 51 men, a mean age of 69.8 ± 17.3 years old). Sixty-six patients began a two-stage management (ERCP + LC), failing to clean the bile duct by endoscopy in 15 cases. LCBE was performed in 59 patients (49 at the beginning and 11 after ERCP failure). Seven of them required conversion to open surgery. RESULTS LCBE approach was more effective in cleaning the bile duct than ERCP (88.1% vs 72.7%; p = 0.032) with no statistics differences in terms of postoperative morbidity or mortality. In the multivariate analysis, the LCBE was an independent factor in the reduction of hospital stay and the economic costs derived from the management of these patients, reducing it 6.13 days (CI95% 2.98 - 9.27; p < 0.001) the hospital stay and 3,218.16€ (CI95% 1,082.4 - 5,354.8; p = 0.001) the costs respect to the classical approach, with an incremental cost-effectiveness index (CEI) of -209. CONCLUSION LCBE is an effective and safe technique. It significantly reduces hospital stay and costs derived from the management of the patients with choledocholithiasis.