LAPARO-ENDOSCOPIC RENDEZVOUS - A NEW TECHNIQUE IN THE CHOLEDOCHOLITHIASIS TREATMENT

BACKGROUND/AIMS: Endoscopic sphincterotomy for common bile duct stone clearance during laparoscopic cholecystectomy may fail due to difficul ties in cannulating the papilla major. In this study we propose a new technique that facilitates the cannulation of the papilla and the comm on Pile duct stone clearance during a standard laparoscopic cholecyste ctomy. Its clearance percentage, complication rate and post-operative stay have been evaluated and compared with standardized procedures suc h as open surgery and endoscopic sphincterotomy before laparoscopic ch olecystectomy. METHODOLOGY: In a group of 16 patients presenting with cholelithiasis and common bile duct stones or papillitis, the sphincte rotome was driven across the papilla into the choledochus by a Dormia basket passed in the duodenum through the cystic duct during laparosco pic cholecystectomy. Measures of outcome were clearance rate, mortalit y, morbidity and hospital stay. Furthermore, data obtained from this s ample of patients were compared with those from another two groups of 16 patients in which choledocholithiasis was managed either by endosco pic sphincterotomy performed before laparoscopic cholecystectomy or by open cholecystectomy and trans-duodenal sphincterotomy. RESULTS: The rate of cannulation of the papilla and of the common bile duct stone c learance was 100% when the combined endo-laparoscopic approach was use d in 15 patients with endoscopic sphincterotomy (93,7%) and in 15 pati ents with open sphincterotomy (93,7%), cholecystectomy was successful in every case. The groups were statistically similar with regard to co mplications; none of the patients required blood transfusion. The mean post operative stay was 95.2 hours (range 48-240) for the first group , 350.1 hours (range 192-1680) for the second and 69.7 hours (range 24 -132) for the third. CONCLUSION: The laparo-endoscopic rendezvous, tho ugh still in evolution, is an efficacious method which can be used dur ing;the laparoscopic strategy of common bile duct clearance.