Laparoscopy usefulness in the management of biliary tract stones

PICHON-RIVIERE A,; AUGUSTOVSKI, F; BARDACH, ARIEL; GARCIA MARTÍ, SEBASTIAN; LOPEZ, A; GLUJOVSKY, D

Documentos de Evaluación de Tecnologías Sanitarias

IECS

Año: 2005 p. 1 - 30

1668-2793

The usefulness of laparoscopy in the management of biliary stones in the common bile duct was evaluated, especially LECBD compared to standard endoscopic techniques.A bibliographic search was carried out on the main data bases (MEDLINE, Cochrane, DARE, LILACS, NHS NICE, EMBASE, DARE, NHS EED and the HTA database), on general Internet search engines, and of sanitary technology evaluation agencies and health suppliersFor this report a consensus on digestive endoscopy of the U.S National Health Institutes, 3 narrative revisions, three controlled randomized clinical trials, and 15 case-series and retrospective cohorts were used. In addition a position statement issued by the U.S. Society of Gastrointestinal Surgeons and Endoscopists was chosen.The main evidence is based on clinical trials with methodological limitations (level IB), and there is not enough information to date to definitely support the choice of one or other therapeutic method.The mortality for both techniques seems to be similar, about 1-1.5%. The effectiveness of LECBD is over 90% in most reports, and it is similar to that of ERCP with sphinterotomy. The short term complications of this endoscopy (ERCP) are about 8% and are related with the procedure (pancreatitis, perforation, bleeding). At middle term, almost 8% present colangitis and recurrent bile duct lithiasis. The long term complications are exceptional. ERCP performed together with laparoscopic cholecystectomy, pre or post surgery has a rate of complications of about 13%. The complications of LECBD include residual stones (5%), need for an open surgery (4%), and residual stenosis (3%). The procedure together with laparoscopic cholecystectomy at the same time leads to a complication rate of 11%, but it can reach 18% depending on the center. In young patients the results are better. The disadvantages of the method include the need to have highly trained surgeons, and the availability of equipment for its performance.In Buenos Aires, the price of LC ranges between $1800 and $2500, and ERCP about $1200 (Argentine pesos 2005). The PMO (from its abbreviation in Spanish-obligatory medical plan) includes the coverage of choledocholithotomy. No coverage policies mentioning this technique were found in other health systems of the world.