Combined endoscopic sphincterotomy and laparoscopic cholecystectomy in patients with choledocholithiasis and cholecystolithiasis

Eighteen symptomatic patients with cholecystolithiasis and choledocholithiasis were prospectively evaluated to assess the efficacy of endoscopic sphincterotomy combined with laparoscopic cholecystectomy as definitive management of simultaneous gallbladder and bile duct stones. The endoscopic management of bile duct stones was successful in all 18 patients. Seventeen patients later had laparoscopic cholecystectomy, and one required conventional cholecystectomy (5.6%; 95% CI, 0.1% to 27.3%). Mean (± SE) duration of postoperative hospitalization (1.6 ± 1.0 days), total hospital stay (5.0 ± 3.5 days), and length of convalescence (9.3 ± 6.6 days) were significantly reduced (P < 0.01 for each) compared with similar measures from a group of 12 consecutive patients treated with conventional cholecystectomy and bile duct exploration (8.3 ± 4.3, 14.1 ± 12.6, and 41.7 ± 10.9 days, respectively). Outcomes in our patients compared favorably with those in patients described in published series of cholecystectomy and bile duct exploration. We found that endoscopic sphincterotomy combined with laparoscopic cholecystectomy is effective in the treatment of patients with simultaneous gallbladder and bile duct stones. Length of hospital stay and degree of postoperative disability were significantly reduced among our patients compared with those having standard cholecystectomy and bile duct exploration.