ERCP IN THE ERA OF LAPAROSCOPIC BILIARY SURGERY - EXPERIENCE WITH 407PATIENTS

Background: The combined endoscopic and laparoscopic treatment of bili ary stones is now highly debated, especially as regards possible compl ications compared to one-step laparoscopic treatment. Methods, This st udy analyzes 407 cases (116 males, 291 females, average age 49 years, range 2-87) observed in the period from May 1991 to July 1994, All pat ients were evaluated preoperatively for the presence of biliary stones . Considering clinical presentation, blood analysis, ultrasonography, and medical history, 99 patients (24%) were selected for preoperative endoscopic retrograde cholangiopancreatography (ERCP). One patient ref used preoperative ERCP. Results: Thirty-nine patients (40%) were found to have biliary stones and were submitted to therapeutic endoscopic s phincterotomy (ES). Endoscopic clearance of the bile ducts was achieve d in all patients, with one complication (pancreatitis), In performing laparoscopic cholecystectomy, no technical difficulties could be attr ibuted to ERCP, nor were there any conversions in patients who had had preoperative ERCP. Average postoperative hospital stay was 2.5 days. During a follow-up period of from 2 to 39 months, we diagnosed three p atients (0.7%) with symptomatic residual stones, They were submitted t o successful ERCP and extraction of the stones. Conclusions: We conclu de that ERCP offers an accurate preoperative selection of patients, al lows for effective planning of treatment, and simplifies laparoscopic surgery.