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Endoscopic retrograde cholangiography in the era of laparoscopic cholecystectomy
K P Balsara1, C R Shah, A Maydeo
1Department of Gastroenterology and Laparoscopic Surgery, Jaslok and Bhatia Hospitals, Bombay.
Objective:
To assess the value of endoscopic retrograde cholangiography (ERC) as an adjunct in patients undergoing laparoscopic cholecystectomy (LC).
Methods:
Four hundred and sixty consecutive patients with cholelithiasis were evaluated for LC over a four-year period (January 1991 to January 1995). Forty four (9.6%) patients underwent pre-operative ERC on a suspicion of harboring common bile duct (CBD) stones. Ten other patients who presented with acute gallstone pancreatitis also had pre-operative ERC as soon as the acute attack had settled. Endoscopic sphincterotomy (ES) and stone extraction were done if indicated. After LC, four patients underwent ERC for cystic or CBD related complications.
Results:
Cannulation was possible in all patients undergoing ERC. Of 44 patients with suspected CBD stones, 33 (75%) actually had stones. In 30 patients the stones could be extracted. Three patients had large stones which could not be extracted. Of 10 patients with acute gallstone pancreatitis, CBD stones were found in only one. In the 4 patients who developed ductal complications, ERC was used to place stents in three and to extract a missed CBD stone in one. Three patients developed fever after ERC and three others had transient hyperamylasemia. There were no other ERC related problems.
Conclusion:
In patients undergoing LC, ERC is a useful adjunct both pre- and post-operatively.