PEROPERATIVE ENDOSCOPIC SPHINCTEROTOMY DURING LAPAROSCOPIC CHOLECYSTECTOMY FOR CHOLEDOCHOLITHIASIS

The development of laparoscopic cholecystectomy has created a dilemma in the management of choledocholithiasis. A number of options exist, i ncluding endoscopic sphincterotomy (ES) before laparoscopic cholecyste ctomy in patients with suspected common bile duct (CBD) calculi, lapar oscopic bile duct exploration, open CBD exploration and postoperative ES. None of these options has emerged as ideal or universally acceptab le. An alternative technique, peroperative ES, has been developed. A p rospective assessment of the use of peroperative ES in 13 patients in whom choledocholithiasis was demonstrated with operative cholangiograp hy is presented. Eleven patients had successful ES and clearance of st ones. The CBD could not be cannulated in one patient, and an adequate ES for stone extraction could not be performed in the remaining patien t. Both procedures were converted to open CBD exploration. Complicatio ns were mild postoperative pancreatitis (two patients) and pulmonary a telectasis (one). The median total operating time was 165 min and the median postoperative hospital stay was 3 days. Peroperative ES at the time of laparoscopic cholecystectomy provides a safe technique for cle arance of the CBD.