THE ROLE OF ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY AND CHOLANGIOGRAPHY IN THE LAPAROSCOPIC ERA

Objective The authors reviewed the results of endoscopic retrograde ch olangiopancreatography (ERCP) and intraoperative cholangiography in a series of patients who underwent laparoscopic cholecystectomy. Summary Background Data The indications for preoperative and postoperative ER CP and intraoperative cholangiography as adjuncts to laparoscopic chol ecystectomy are evolving. The debate regarding the use of selective or routine intraoperative cholangiography has intensified with the adven t of laparoscopic cholecystectomy. Methods The authors reviewed the re cords of 343 consecutive patients who underwent laparoscopic cholecyst ectomy during a 1-year period. Historical, biochemical, and radiologic findings for the patients who underwent ERCP and intraoperative chola ngiography were analyzed. Results Three hundred forty-three patients u nderwent laparoscopic cholecystectomy during the period reviewed. Preo perative ERCP was performed in 42 patients. Twenty-seven of these pati ents (64%) had common bile duct (CBD) stones, which were cleared with a sphincterotomy. Intraoperative cholangiography was performed for 101 patients (29%). Three cholangiograms had false-positive results (3%), leading to two CBD explorations, in which no CBD stones were found, a nd one normal ERCP. Six patients underwent postoperative ERCP, three f or the removal of retained CBD stones (0.9%), all of which were cleare d with a sphincterotomy. Fifteen patients had gallstone pancreatitis, six of whom had CBD stones (40%) that were cleared by ERCP. There were 33 complications (10%) and no CBD injuries.Conclusion The use of rout ine intraoperative cholangiography is discouraged in view of its low y ield and the significant rate of false positive cholangiogram results.