TREATMENT OF GALLSTONES ASSOCIATED TO BIL E-DUCT OBSTRUCTION USING ERCP AND LAPAROSCOPIC CHOLECYSTECTOMY

Objective. To analyze the efficacy of a combined approach using ERCP p lus laparoscopic cholecystectomy in the treatment of gallstones associ ated to benign common bile duct obstruction. Design. Prospective study . Setting. Tertiary-care medical center. Patients. From a total of 270 laparoscopic cholecystectomies performed between October 1991 and Jan uary 1994, a group of 25 patients in whom preoperative ERCP was perfor med to rule out bile duct obstruction was selected for analysis. Resul ts. Choledocholithiasis was documented in nine patients (36%). In eigh t of them, stones were retrieved by ERCP. The diagnosis of odditis was established in five patients and a papilotomy was performed. The enti re bile duct was normal in 11 cases. All patients in whom the common b ile duct was normal, or cleared endoscopically, underwent laparoscopic cholecystectomy uneventfully. There was one complication of papilotom y. Duodenal perforation occurred in one patient who ultimately died. C onclusion. The combined approach using ERCP followed by laparoscopic c holecystectomy seems to be adequate for the treatment of gallstones as sociated to bile duct obstruction.