[Endoscopy and laparoscopy in the treatment of lithiasic cholecystitis associated with benign bile duct obstruction]
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A Palacios-Macedo1, M F Herrera, M A Morán
1Departamento de Cirugía, Instituto Nacional de la Nutrición Salvador Zubirán, México, D.F.
Objective:
To analyze the efficacy of a combined approach using ERCP plus laparoscopic cholecystectomy in the treatment of gallstones associated to benign common bile duct obstruction.
Design:
Prospective study.
Setting:
Tertiary-care medical center.
Patients:
From a total of 270 laparoscopic cholecystectomies performed between October 1991 and January 1994, a group of 25 patients in whom preoperative ERCP was performed to rule out bile duct obstruction was selected for analysis.
Results:
Choledocholithiasis was documented in nine patients (36%). In eight of them, stones were retrieved by ERCP. The diagnosis of odditis was established in five patients and a papilotomy was performed. The entire bile duct was normal in 11 cases. All patients in whom the common bile duct was normal, or cleared endoscopically, underwent laparoscopic cholecystectomy uneventfully. There was one complication of papilotomy. Duodenal perforation occurred in one patient who ultimately died.
Conclusion:
The combined approach using ERCP followed by laparoscopic cholecystectomy seems to be adequate for the treatment of gallstones associated to bile duct obstruction.