Intraoperative ERCP for management of cholecystocholedocholithiasis

The introduction of minimally invasive techniques in management of biliary problems added new procedures for treating patients with cholecystocholedocholithiasis (CCL). This study presents the results of intraoperative ERCP (IOERCP) during LC as a single-session minimally invasive procedure for management of patients who have preoperatively diagnosed CBD stones.

The database of patients presented to our center by CCL between October 2007 and December 2015 who were treated by LC and IOERCP was collected and analyzed. CBD stones were diagnosed using clinical data, laboratory tests and abdominal sonogram. MRCP was requested for doubtful cases. In the first cases ERCP was done using rendezvous technique, but in late cases standard ERCP immediately after completion of LC under the same anesthesia was used. Preoperative, intraoperative and postoperative data were recorded, analyzed and reported. Data reported include success/failure rate, complications, conversion to open surgery, operative details and incidence of residual CBD stones.

The study was conducted on 346 patients who had CCL. The mean age was 34.7 years, and 298 of them were females. The most common presentation was abdominal pain (98.5 %) and jaundice (64.9 %). Fifteen patients were excluded, and IOERCP was not done due to negative IOC results in 10 patients and conversion to open surgery in 5 patients. IOERCP was tried in the remaining 331 patients. The mean operative time was 55 min, and the mean hospital stay was 2.4 days. Major complications had been reported in 13/323 patients (4.0 %). Failure of CBD clearance was reported in 8 patients (2.4 %) with a success rate of 97.6 %. Thirty-day follow-up was possible in 142 patients, and there was a residual CBD stone in one patient and wound infection in another one.

IOERCP during LC is a safe and effective option for management of CCL.