The role of ERCP and therapeutic biliary endoscopy in laparoscopic cholecystectomy

The widespread use of laparoscopic cholecystectomy for the treatment of symptomatic gallstones has been associated with an increased use of diagnostic and therapeutic biliary endoscopy to treat common bile duct stones and postoperative complications. In 250 patients with successful laparoscopic cholecystectomy, 35 were selected for preoperative ERCP evaluation after fitting the criterion of clinical evidence with common bile duct stones (ultrasound and biochemical data). Stones were found in 16 of 35 patients (45.7%). Endoscopic sphincterotomy with stone removal was successfully carried out during the procedure. Laparoscopic cholecystectomy was performed 1 or 2 days after endoscopic sphincterotomy with good result. Only one patient without clinical evidence of common bile duct stones developed postoperative retained stone; he was successfully treated by endoscopic sphincterotomy. Three patients with postoperative bile leakage were successfully treated with endoscopic nasobiliary drainage. Diagnostic and therapeutic ERCP procedures should incorporate the newly developed method of laparoscopic cholecystectomy in order to provide a more safe and minimal invasive therapy.