Combined intraoperative laparoscopic cholecystectomy and endoscopic retrograde cholangiopancreatography - Lessons from 29 cases

Background: The role and timing of endoscopic retrograde cholangiopancreato graphy (ERCP) in patients with suspected choledocholethiasis remains a cont roversial subject. There have been few studies exploring the role of intrao perative ERCP. Therefore, we set out to perform a retrospective review of 2 9 patients who underwent combined laparoscopic cholecystectomy (LC) and int reoperative ERCP (LC/ERCP). Our objective was to assess the feasibility of a one-stage approach using intraoperative ERCP. Methods: We identified 29 patients in whom LC/ERCP was attempted between Ja nuary 1996 and November 1998 at a university-affiliated hospital with a lar ge private faculty. Parameters reviewed included preoperative diagnosis, li ver function tests (LFT), finding on transcystic cholangiogram (TCC), ERCP, stone retrieval, failure of ERCP, length of stay, morbidity, and mortality . Results: Twenty-eight of 29 patients (97%) underwent successful combined LC /ERCP. Successful TCC followed by ERCP was performed in 21 of 26 patients ( 81%). Five TCC were technically unsuccessful; in these patients, ERCP was p erformed on the basis of preoperative criteria. In three patients, TCC was not attempted. Stones were successfully retrieved from 20 of 21 patients (9 5%) with abnormal finding on TCC, one of five patients (20%) with failed TC C, and two of three patients (67%) with ERCP but without TCC. Overall morbi dity was 14%, comprising two patients with postoperative hyperamylasemia an d two with cystic duct leaks. There were no deaths in the group. The mean t ime for the combined procedure was 173 min (range, 50-290). Mean length of hospitalization was 3.4 days, and mean postoperative stay was 2.2 days. Conclusions: LC/ERCP can be performed safely. The advantages of the combine d procedures include one-stage treatment of cholelithiasis and choledocholi thiasis, avoidance of unnecessary preoperative ERCP and their concomitant c omplications, and elimination of potential return to the operating room whe n postoperative ERCP is technically impossible.