SELECTIVE PREOPERATIVE ENDOSCOPIC RETROGRADE CHOLANGIOGRAPHY WITH SPHINCTEROTOMY AVOIDS BILE-DUCT EXPLORATION DURING LAPAROSCOPIC CHOLECYSTECTOMY

A policy of preoperative endoscopic retrograde cholangiography (ERC) f or suspected bile duct stones was used in 1507 patients considered for laparoscopic cholecystectomy in three district general hospitals. Alt ogether 306 patients underwent ERC, and bile duct cannulation was achi eved in 276 (90%). Bile ducts were cleared by endoscopic sphincterotom y in 128 of 161 patients (79%) with proven duct stones. Laparoscopic c holecystectomy was completed in 1396 patients. Ten laparotomies were n ecessary for complications of laparoscopic cholecystectomy. The compli cation rate for endoscopic sphincterotomy/laparoscopic cholecystectomy was 2.7%, with no mortality. Overall, a combined endoscopic/lagarosco pic approach succeeded in 1386 patients (92%). Fourteen patients (1%) had retained stones during a median of 14 months (range 1-42) follow u p, all of which were removed by ERC/endoscopic sphincterotomy. If a po licy of selective ERC before laparoscopic cholecystectomy is used for all patients with symptomatic gall stones, most will avoid an open ope ration and laparoscopic exploration of the bile duct is not necessary.