Endoscopic retrograde cholangiopancreatography: before and after laparoscopic cholecystectomy

In 39 patients with indication of laparoscopic cholecystectomy (LC), an endoscopic cholangiopancreatography (ERCP) was performed before the procedure whenever intermittent cholestasis, acute pancreatitis or ultrasonografic biliary tract dilatation were detected. No abnormality was found in 24 of them. In 14, bile duct stones were removed by endoscopic sphincterotomy (EST). Later they were submitted to LC, and no complication was observed. Only 1 patient with cholangiografic diagnosis of Mirizzi's syndrome underwent open cholecystectomy. Twenty-four patients were referred to ERCP between 2 and 210 days following LC, after development of complications. The etiology of these complications could be established in all the cases. Sixteen patients had bile duct stones, 14 of them were treated successfully by EST and 2, with multiple stones, required open surgery extraction. Four patients had cystic bile leaks, of which 1 healed spontaneously, 1 closed his fistula after EST and removal of stones, 1 cured after a nasobiliary tube was inserted endoscopically and 1 required surgical treatment. Four patients with complete obstruction of common bile duct by misplaced clips received surgical treatment. We conclude that ERCP is indicated before LC in patients with clinical, humoral or ultrasound findings of extrahepatic cholestasis. The application of EST plus LC systematically in cases of biliary duct stones remains still controversial. We agree that ERCP is an excellent method in the diagnosis and treatment of LC complications.