Abstract
Background
With the evolution of laparoscopic cholecystectomy (LC) as the standard operation for benign gallbladder disease, the role of endoscopic retrograde cholangiopancreatography (ERCP) in the management of common bile duct (CBD) stones has to be defined.
Methods
From November 1990 to April 1994 we attempted LC in 1,788 patients. Eighty-nine patients underwent ERCP preoperatively under the following indications: jaundice or a history of jaundice, cholangitis, gallstone pancreatitis, abnormal liver function tests, and a sonogram showing either CBD stones or a dilated CBD. With intent to minimize the number of unnecessary ERCPs only patients with jaundice, cholangitis, and high abnormalities on the liver function tests (LFTs) were directly referred for ERCP. All other patients with suspected choledocholithiasis were initially investigated with intravenous cholangiography (IVC) and tomography; only patients with positive findings on IVC subsequently underwent ERCP. Eighteen patients underwent ERCP postoperatively and the indications included jaundice, bile leak, and abnormal intraoperative cholangiogram.
Results
Of the 89 patients having ERCP preoperatively 54 patients (60.7%) were found to have CBD stones which were removed endoscopically in all cases except in one patient where a large CBD stone was removed during laparoscopic exploration of the CBD. Eight patients of the 18 patients having ERCP postoperatively were found to have CBD stones and all of them had their CBD cleared endoscopically. There were no mortalities, while four patients developed a mild pancreatitis.
Conclusions
Although there is an increasing tendency to clear the bile duct with a laparoscopic approach, ERCP and sphincterotomy has a certain role in conjunction with LC in the management of patients with a high suspicion of CBD stones, particularly in institutions where there is easy access to expert interventional endoscopic techniques.
Similar content being viewed by others
References
Arregui ME, Davis CJ, Arkush AM, Nagan RF (1992) Laparoscopic cholecystectomy combined with endoscopic sphincterotomy and stone extraction or laparoscopic choledochoscopy and electrohydraulic lithotripsy for management of cholelithiasis with choledocholithiasis. Surg Endosc 6: 10–15
Berci G (1993) Preoperative ERCP and intraoperative cholangiography in the age of laparoscopic cholecystectomy. Surg Endosc 7: 2
Caroll BJ, Fallas MJ, Phillips EH (1994) Laparoscopic transcystic choledochoscopy. Surg Endosc 8: 310–314
Cotton P, Lehman G, Vennes J, Geenen JE, Russell RCG, Meyers WC, Ligoury C, Nicki N (1991) Endoscopie sphincterotomy complications and their management: an attempt at consensus. Gastrointest Endosc 37: 383–393
Cotton PB (1993) Endoscopie retrograde cholangiopancreatography and laparoscopic cholecystectomy. Am J Surg 165: 474–478
Croce E, Azzola M, Russo R, Golia M, Pompa C, Ubezio D, Dal Cin S (1993) Early and late results of laparoscopic choledochotomy without biliary drainage. End Surg 1: 130–132
Edelman DS (1994) Bile leak from the liver bed following laparoscopic cholecystectomy. Surg Endosc 8: 205–207
Cuschieri A, Shimi S, Banting S, Nathanson LK, Pietrabissa A (1994) Intraoperative cholangiography during laparoscopic cholecystectomy. Surg Endosc 8: 302–305
Ferzli GS, Massaad A, Kiel T, Worth MH (1994) The utility of laparoscopic common bile duct exploration in the treatment of choledocholithiasis. Surg Endosc 8: 296–298
Fink AS (1993) To ERCP or not to ERCP? That is the question. Surg Endosc 7: 375–376
Jenkins MA, Ponsky JL, Lehman GA, Fanelli R, Bianchi T (1994) Treatment of bile leaks from the cystohepatic duct after laparoscopic cholecystectomy. Surg Endosc 8: 193–196
Kum CK, Goh PMY (1994) Laparoscopic cholecystectomy: the Singapore experience. Surg Laparosc Endosc 4: 22–24
Leese T, Neoptolemos JP, Carr-Locke L (1985) Successes, failures, early complications and their management following endoscopie sphincterotomy: results in 394 consecutive patients from a single centre. Br J Surg 72: 215–219
Morris JB, Margolis R, Rosato E (1993) Safe laparoscopic cholecystectomy without intraoperative cholangiography. Surg Laparosc Endosc 3: 17–20
Petelin JB (1993) Clinical results of common bile duct exploration. End Surg 1: 125–129
Sackier JM, Berci G, Phillips E, Carroll B, Shapiro S, Paz-Partlow M (1991) The role of cholangiography in laparoscopic cholecystectomy. Arch Surg 126: 1021–1026
Salky B, Bauer J (1994) Intravenous cholangiography, ERCP and selective operative cholangiography in the performance of laparoscopic cholecystectomy. Surg Endosc 8: 289–291
Surick B, Washington M, Ghazi A (1993) Endoscopie retrograde cholangiopancreatography in conjunction with laparoscopic cholecystectomy. Surg Endosc 7: 388–392
Vitale GC, Larson GM, Wieman RJ, Cheadle WG, Miller FB (1993) The use of ERCP in the management of common bile duct stones in patients undergoing laparoscopic cholecystectomy. Surg Endosc 7: 9–11
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Bonatsos, G., Leandros, E., Polydorou, A. et al. ERCP in association with laparoscopic cholecystectomy. Surg Endosc 10, 37–40 (1996). https://doi.org/10.1007/s004649910009
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/s004649910009