SELECTIVE USE OF ERCP IN PATIENTS UNDERGOING LAPAROSCOPIC CHOLECYSTECTOMY

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.