Selective use of perioperative ERCP in patients undergoing laparoscopic cholecystectomy

Background/Aims: Management of common bile duct stones in the era of laparo scopic surgery is still controversial. The purpose of this study is to inve stigate the safety, feasibility, success rate and short-term results of the selective use of endoscopic retrograde cholangiopancreatography in patient s undergoing laparoscopic cholecystectomy. Methodology: A prospective study comprising 300 consecutive patients with e ither symptomatic or complicated gallbladder stones was performed between J anuary 1994 and November 1996. Depending on clinical, laboratory and ultras onographic criteria, 73 patients (24.3%) underwent endoscopic retrograde ch olangiopancreatography with or without endoscopic sphincterotomy. The proce dure was successful in 71 patients (97%) either preoperatively in 62 patien ts (21%) or postoperatively in 9 patients (3%). Results: Endoscopic retrograde cholangiopancreatography was positive in 37 cases (52%), endoscopic sphincterotomy and stone extraction was performed i n 35 cases and endoscopic sphincterotomy alone was performed in 2 cases for benign papillary stenosis. The overall predictive value for the presence o f common bile duct stone was 52%, the predictive value for patients with ja undice, dilated common bile duct together with elevated liver enzymes was 7 3.3%. Complications of perioperative endoscopic retrograde cholangiopancrea tography were encountered in 4 patients (5.5%) with no mortality. Conclusions: We conclude that the combination of perioperative endoscopic r etrograde cholangiopancreatography and laparoscopic cholecystectomy is a us eful approach for the management of choledochocholelithiasis.