MANAGEMENT OF CHOLEDOCHOLITHIASIS IN THE TIME OF LAPAROSCOPIC CHOLECYSTECTOMY

BACKGROUND: The best way to detect and manage common duct stones in co njunction with laparoscopic cholecystectomy is not agreed upon at the present time. PATIENTS AND METHODS: Our experience with choledocholith iasis in a consecutive series of 1,123 cholecystectomies (94% by lapar oscopy) has been reviewed. Suspected duct stones were investigated pre operatively or postoperatively by endoscopic retrograde cholangiograph y (ERC), and if necessary, duct clearance was attempted by endoscopic sphincterotomy (ES). Mo attempt was made to identify choledocholithias is intraoperatively. RESULTS: Endoscopic retrograde cholangiography wa s performed in 11% of patients, and 32% of these required ES. The comp lication rate of ERC and ES was 8%, without mortality. Two patients re quired a second operation for missed choledocholithiasis, for a reoper ation rate of 0.2%. CONCLUSION: We believe that primary or secondary o pen surgery is only occasionally necessary for the management of chole docholithiasis. Preoperative ERC and ES for suspected duct stones, wit h the same strategy employed as a salvage for stones presenting after cholecystectomy, was safe and efficient. (C) 1997 by Excerpta Medica, Inc.