ENDOSCOPIC BILE-DUCT STONE REMOVAL PRIOR TO LAPAROSCOPIC CHOLECYSTECTOMY

Of 1049 patients referred for laparoscopic cholecystectomy (LC) for sy mptomatic gallstone disease, 67 (6%) had clinical, biochemical, or ech ographic findings suggesting common bile duct stones. Patients in this group were studied preoperatively with endoscopic retrograde cholangi opancreatography (ERCP). In 26 patients (39%), the diagnosis was confi rmed. In 12 other cases (18%), the macroscopic finding of a stripped o r bleeding papilla without common bile duct stones suggested stone mig ration. ERCP in the remaining 29 patients (43%) was normal. Thirty-fou r endoscopic sphincterotomies (ES) were performed, 26 for common bile duct stones and 8 for cystic lithiasis or gallbladder microlithiasis. In the entire group of patients with choledocholithiasis, stone remova l was possible. All 67 patients underwent laparoscopic cholecystectomy on an average of 2.8 days following the endoscopic procedure. Twenty- one patients (31%) had acute cholecystitis, and 5 had chronic scleroat rophic cholecystitis. Five (7.5%) of the 67 patients were converted to an open procedure. In 10 cases (16%), the cystic diameter was larger than an 8-mm M-L clip, which made necessary the use of endoligature or extra clips. No complications or deaths resulted from ERCP or ES. Two of the 62 patients (3.2%) who underwent LC had to be reoperated on, 1 because of a right subphrenic collection, and the other because of bi lious ascites. No common bile duct lesions or deaths resulted in the a nalyzed group. The average hospitalization time, with the exception of those patients converted or reoperated on, was 8 days.