SELECTIVE USE OF PREOPERATIVE ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY IN LAPAROSCOPIC CHOLECYSTECTOMY

Background: The management of possible common bile duct (CBD) stones i n patients scheduled for laparoscopic cholecystectomy remains controve rsial. Methods: Prospective evaluation of 609 patients who underwent l aparoscopic cholecystectomy was carried out in relation to the use of selective preoperative ERCP for detection of common duct stones. Preop erative ERCP was performed if there is or has been (1) cholangitis, bi liary pancreatitis, or jaundice; (2) abnormal serum liver tests or (3) ultrasonogram showing a dilated CBD or ductal stones. Results: A tota l of 139 patients underwent preoperative ERCP, and cannulation of CBD was successful in 133 patients (96%). CBD stones were found in 60 pati ents (45%) and extracted after sphincterotomy. High prevalence of CBD stones was noted in patients with acute cholangitis and CBD stones on ultrasonogram. There were six endoscopic sphincterotomy-related compli cations (complication rate, 4.5%): bleeding (2), pancreatitis (3), ret roduodenal perforation (1). No patient required surgery as the result of a complication. The prediction of the occurrence of ductal stones w as further analyzed using stepwise logistic regression. Acute cholangi tis and CBD stones on ultrasonogram were shown to be independent signi ficant risk factors with odds ratios of 8.9 and 13.5, respectively. Co nclusions: With selective preoperative ERCP, suspected CBD stones can be identified and removed prior to laparoscopic cholecystectomy.