M. Tanaka et al., COMPARISON OF ROUTINE AND SELECTIVE ENDOSCOPIC RETROGRADE CHOLANGIOGRAPHY BEFORE LAPAROSCOPIC CHOLECYSTECTOMY, World journal of surgery, 20(3), 1996, pp. 267-271
To evaluate the role of endoscopic retrograde cholangiography (ERC) be
fore laparoscopic cholecystectomy, we compared the frequency of concom
itant common bile duct stones, their clinical outcome, and the frequen
cy of bile duct injury between a group of 128 patients with routine pr
eoperative ERC (group A) and 1010 patients with selective ERC (group B
). Overall, 48 patients (4.2%) had duct stones, but the predictive sig
ns were absent in six of them (12.5%). The stones were demonstrated by
ERC and removed by sphincterotomy in all 11 patients in group A. Of 3
7 patients in group B, 22 were diagnosed by selective ERC and underwen
t endoscopic removal. Of four patients whose stones were found by oper
ative cholangiography, one had immediate open surgery, another passed
a stone spontaneously, and the other two underwent postoperative sphin
cterotomy, which failed in one. The stones were not recognized until p
ain recurred in the remaining 11 patients. Sphincterotomy was successf
ul in nine patients but failed in the other two. Thus postoperative sp
hincterotomy failed in 3 of 13 patients (23%), necessitating open surg
ery. Forty-two patients overall (3.7%) had aberrant biliary tract anat
omy, which did not lead to bile duct injury in any of the patients. Mo
rbidity of routine ERC (3.1%) was lower than that of selective ERC (7.
4%) (p < 0.05). It should be noted that a certain proportion of duct s
tones may be missed by selective ERC, necessitating laparotomy when sp
hincterotomy fails. The routine use of preoperative ERC may be justifi
ed at institutions where the expertise is available, at least until la
paroscopic lithotomy becomes easy.