PREOPERATIVE ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY - THERAPEUTIC IMPACT IN A GENERAL-POPULATION OF PATIENTS NEEDING A CHOLECYSTECTOMY

Background/Aims: The place of endoscopic retrograde cholangiopancreato graphy (ERCP) before open or laparoscopic cholecystectomy remains cont roversial. Most of the reports study highly selected series of patient s and therefore do not give a survey of the actual situation in a gene ral population. We describe here the therapeutic impact of preoperativ e ERCP in a continuous cohort of patients needing a cholecystectomy. M aterials and Methods: Data concerning a 2-year continuous and unselect ed series of 452 patients undergoing cholecystectomy were evaluated. R esults: Two hundred ninety-three patients (65%) presented with a chron ic symptomatic biliary lithiasis and 159 patients (35%) with a complic ated biliary lithiasis. A preoperative ERCP was performed in 206 patie nts, all presenting with a suspicion of associated lithiasis sphincter otomy was performed in 106 patients: 44 patients presented with CBD st ones (9.7%), all successfully cleared by endoscopy. Laparoscopic chole cystectomy has been attempted in 367 patients (81%) and sucessfully pe rformed in 333 patients (74%). Laparotomy as a first-choice procedure was performed in 85 patients (19%). Surgical choledochotomy was never performed in 85 patients (19%). Surgical choledochotomy was never perf ormed. Postoperative ERCP was needed in 4 patients (0.88%) and in only 1 of them for a retained CBD stone (0.22%). Conclusion: In a continuo us series of patients needing a cholecystectomy, preoperative ERCP was performed on the basis of suspected CBD disorders. It allows CBD ston e detection and extraction in almost 10% of the patients and avoids pe roperative CBD exploration, with a very low rate of retained stones af ter surgery. The association of preoperative ERCP with subsequent lapa roscopic cholecystectomy (when feasible) offers the patient a quick re covery and a short hospital stay.