LAPAROSCOPIC TREATMENT OF CHOLECYSTOCHOLI THIASIS AND CHOLEDOCHOLITHIASIS IN A SINGLE PROCEDURE - ANALYSIS OF RESULTS

Introduction: With the advent of laparoscopic cholecystectomy, ERCP ha s gained importance in the treatment of choledocholithiasis. Laparosco pic cholecystectomy with intraoperative cholangiography and common bil e duct surgery allows diagnosis and treatment of cholecystolithiasis a nd choledocholithiasis in a single procedure. Patients and methods: La paroscopic treatment of choledocholithiasis was evaluated in 99 consec utive patients with choledocholithiasis. 28 patients underwent success ful preoperative ERCP. Of the patients with intraoperative confirmatio n of choledocholithiasis, removal was attempted by a transcystic appro ach in 36 and 23 underwent choledochotomy. 24 patients with a high ope rative risk underwent postoperative ERCP. Results: The transcystic app roach was successful in 72.2%. Choledochotomy was successful in 91.3%, yielding a combined success rate of 80%. 3.4% had local complications and 8.4% had other complications (complication rate 11.8%). 20.3% of the patients underwent ERCP after failed laparoscopic procedures. One patient had a laparoscopic redo. There was no mortality and no convers ion to open surgery. Conclusion: ERCP and laparoscopic common bile duc t surgery are complementary, efficient and safe modalities of treatmen t for choledocholithiasis. Choice of procedure is influenced by the su rgeon's experience and institutional infrastructure, and the individua l patient.