The interface of endoscopic retrograde cholangiopancreatography and laparoscopic cholecystectomy

The expanding use of laparoscopic cholecystectomy in conjunction with intraoperative cholangiography and laparoscopic common bile duct exploration has caused a reexamination of the indications of preoperative ERCP. Several studies have demonstrated the benefits of early preoperative ERCP in patients with severe gallstone pancreatitis and acute cholangitis. Those patients with only mild biochemical or radiographic abnormalities suggestive of choledocholithiasis present a clinical dilemma. The optimal diagnostic and therapeutic approach in these patients will depend on the level of expertise of both the biliary endoscopist and laparoscopist. The interface of laparoscopic cholecystectomy and ERCP will continue to evolve as surgeons become more facile with the techniques of laparoscopic common bile duct exploration. When these laparoscopic skills become widely disseminated, the use of ERCP will most likely be relegated to its well-established role in the open cholecystectomy era.