With the advent of laparoscopic cholecystectomy (LCH) various strategi
es have been proposed for the management of common bile duct (CBD) sto
nes. In a consecutive series of 1140 patients subjected to LCH, preope
rative endoscopic retrograde cholangiopancreatography (ERCP) was attem
pted in 128 patients (11.2%) and successfully accomplished in 121 (94.
5%). Based on the prediction of CBD stones by laboratory tests, ultras
onography, and intravenous cholangiography, prelaparoscopic ERCP was p
erformed in 106 patients (9.3%). CBD stones were identified in 56 pati
ents and benign papillary stenosis in 5 patients (57.5%). Of these 61
patients, 58 (95%) were treated by endoscopic sphincterotomy (ES) and
stone extraction followed by LCH after a mean interval of 1.6 days. Th
ree patients with failure of endoscopic ductal stone extraction requir
ed open CBD exploration. In 39 of the 106 patients (36.8%) ERCP was ne
gative for ductal stones but revealed unexpected ampullary and pancrea
tic cancer in two cases. Six patients (of the 106) with preoperative E
RCP cannulation failure (5.7%) were managed either by LCH and intraope
rative cholangiography or by open CBD exploration. In 22 of the 1140 t
otal patients (1.9%) ERCP was performed at various intervals after LCH
. Retained CBD stones were found in eight patients, and ES and ductal
clearance was achieved in all eight. There was no mortality among the
entire surgical group who underwent perioperative ERCP/ES. Including t
wo cases of ES-related pancreatitis, the overall morbidity was 5.5% (7
of 128). Perioperative ERCP/ES in conjunction with LCH is an attracti
ve approach for patients with cholecystocholedocholithiasis, at least
until laparoscopic ductal clearance becomes a standard procedure.