Single-step treatment of gallbladder and bile duct stones: a combined endoscopic-laparoscopic technique

Background: The introduction of laparoscopic cholecystectomy has given rise to a debate as to whether endoscopic retrograde cholangiopancreatography ( ERCP) should be performed before or after cholecystectomy in patients with bile duct stones. Methods: This study evaluated the efficacy of treatment of cholecystocholed ocholithiasis in a single step by performing ERCP during surgery in 52 pati ents (35 women, 17 men; mean age 57.0 years; age range 20 to 89 years). Lap aroscopic intraoperative cholangiography via the cystic duct was carried ou t to confirm the presence of duct stones. A soft-tipped guidewire was passe d through the cystic duct and papilla into the duodenum, A papillotome was inserted endoscopically over the guidewire, Endoscopic sphincterectomy was performed and the stones removed with balloon and basket catheters. Results: Endoscopic stone removal was successful in 94% of cases without co mplications related to ERCP or surgery. Although operative time was lengthe ned by about 20 minutes, the hospital stay was as short and equal to that f or simple laparoscopic cholecystectomy (3 days on average). Conclusions: The single-step combined endoscopic-laparoscopic technique is safe and effective for treatment of patients with gallbladder and bile duct stones.