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Use of the laparoscopic–endoscopic approach, the so-called “rendezvous” technique, in cholecystocholedocholithiasis

A valid method in cases with patient-related risk factors for post-ERCP pancreatitis
  • F. Lella
  • F. Bagnolo
  • C. Rebuffat
  • M. Scalambra
  • U. Bonassi
  • E. Colombo
Article

Abstract

Background

Several studies have shown the efficacy and effectiveness of the combined endoscopic–laparoscopic “rendezvous” technique for treatment of gallbladder and bile duct stones without complications, particularly pancreatitis. The so-called rendezvous technique consists of laparoscopic cholecystectomy standards with intraoperative cholangiography followed by endoscopic sphincterotomy (EST). The sphincterotome is driven across the papilla through a guidewire inserted by the transcystic route. This method allows easier and faster cannulation, thus avoiding papillary edema and pancreatic trauma. The aim of this study was to evaluate whether this method is effective in eliminating ductal stones and to verify whether the risk of postprocedure pancreatitis is diminished.

Methods

From January 2002 to September 2004, we enrolled 256 patients with cholecystocholedolithiasis detected by transabdominal ultrasound and magnetic resonance cholangiopancreatography. One hundred and twenty of these had one or more patient-related risk factors for post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis, so they were randomized into two groups of 60 patients. In group A, the patients were treated in a single step with videolaparoscopic cholecystectomy, intraoperative cholangiography, and EST during the surgical procedure with the rendezvous technique. In group B, preoperative ERCP and EST were performed by using a traditional method of bile duct cannulation.

Results

No cases of post-ERCP pancreatitis were observed in group A, whereas six cases of acute post-ERCP pancreatitis occurred in group B (five mild and one moderate) (p = 0.0274). No procedure-related mortality was recorded.

Conclusion

In cholecysthocholedocholithiasis, the combined laparoscopic–endoscopic approach prevents post-ERCP pancreatitis in cases with patient-related risk factors for this complication.

Keywords

Technical Endoscopy, Complication, Cholecystectomy, CBD (Common Bile Duct), Bilio 

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Copyright information

© Springer Science+Business Media, Inc. 2006

Authors and Affiliations

  • F. Lella
    • 1
  • F. Bagnolo
    • 1
  • C. Rebuffat
    • 2
  • M. Scalambra
    • 2
  • U. Bonassi
    • 1
  • E. Colombo
    • 1
  1. 1.Department of GastroenterologyPoliclinico San MarcoZingoniaItaly
  2. 2.Department of SurgeryPoliclinico San MarcoZingoniaItaly

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