COMBINED LAPAROSCOPIC AND ENDOSCOPIC TREATMENT OF GALLSTONES AND BILE-DUCT STONES - A PROSPECTIVE-STUDY

In patients with symptomatic gallstones the management of choledocholi thiasis has been controversial since the introduction of laparoscopic cholecystectomy. A prospective study was made of 300 consecutive patie nts with symptomatic gallstones managed by laparoscopic cholecystectom y and preoperative endoscopic retrograde cholangiography (ERC) over 2 years. Fourteen patients were excluded either because urgent surgery w as required or because they were unfit for laparoscopic cholecystectom y. ERC was performed on 96 patients (34 per cent) who were at risk of choledocholithiasis. The presence of bile duct calculi was confirmed i n 59 patients (21 per cent of the total, 61 per cent of those undergoi ng ERC); stones were removed endoscopically in 53 cases (90 per cent o f attempts). The remaining six patients underwent open cholecystectomy and bile duct exploration. Laparoscopic cholecystectomy was attempted in 280 patients (98 per cent); it was necessary to convert to open op eration in only three (1 per cent). There were no deaths, no retained stones and no bile duct injuries, and only three patients (1 per cent) developed a significant postoperative complication. Symptomatic galls tones can be managed by preoperative ERC and laparoscopic cholecystect omy with minimal morbidity and mortality.