Laparoscopic cholecystectomy and intraoperative endoscopic sphincterotomy in the treatment of cholecysto-choledocholithiasis

Background: A single-stage minimally invasive procedure would be optimal fo r management of cholecysto-choledocholithiasis. Two alternative strategies are available: management by laparoscopy alone or a combined laparoscopic-e ndoscopic approach. This study evaluates the results of the latter procedur e. Methods: From June 1993 to September 1997, 1400 patients with symptomatic b iliary stone disease were evaluated for laparoscopic cholecystectomy. Intra operative cholangiography was performed on the basis of a preoperative susp icion of bile duct stones; bile duct stone treatment was by intraoperative endoscopic retrograde sphincterotomy. Results: Intraoperative cholangiography was performed because of a preopera tive suspicion of a bile duct abnormality in 141 of 1400 patients (10%) und ergoing laparoscopic cholecystectomy because of biliary stone disease. Of t hose 141 patients, 54 (38.3%) presented with pathologic findings (bile duct stone [52] and papillary stenosis [2]); all 54 underwent intraoperative en doscopic sphincterotomy. Complete clearance of the ductal stones was achiev ed in 43 patients (82.7%) by intraoperative sphincterotomy, and in 9 patien ts by an additional postoperative endoscopic procedure. Laparoscopic cholec ystectomy was carried out in all cases. There were no conversions to an ope n operation. Postoperative course in the uncomplicated cases was comparable to that for laparoscopic cholecystectomy alone. The postoperative complica tion rate was 5.6% and mortality 1.8%. Mean hospital stay was 3.3 days (ran ge 2 to 16). At a mean 38 months follow-up, no complications related to the laparoscopic-endoscopic procedure were observed. Conclusion: The intraoperative combined laparoscopic-endoscopic approach se ems to be a feasible and effective management of cholecysto-choledocholithi asis, saving patients a subsequent invasive procedure.