The role of endoscopic retrograde cholangiopancreatography and cholangiography in the laparoscopic era.
OBJECTIVE
The authors reviewed the results of endoscopic retrograde cholangiopancreatography (ERCP) and intraoperative cholangiography in a series of patients who underwent laparoscopic cholecystectomy.


BACKGROUND
The indications for preoperative and postoperative ERCP and intraoperative cholangiography as adjuncts to laparoscopic cholecystectomy are evolving. The debate regarding the use of selective or routine intraoperative cholangiography has intensified with the advent of laparoscopic cholecystectomy.


METHODS
The authors reviewed the records of 343 consecutive patients who underwent laparoscopic cholecystectomy during a 1-year period. Historical, biochemical, and radiologic findings for the patients who underwent ERCP and intraoperative cholangiography were analyzed.


RESULTS
Three hundred forty- three patients underwent laparoscopic cholecystectomy during the period reviewed. Preoperative ERCP was performed in 42 patients. Twenty-seven of these patients (64%) had common bile duct (CBD) stones, which were cleared with a sphincterotomy. Intraoperative cholangiography was performed for 101 patients (29%). Three cholangiograms had false- positive results (3%), leading to two CBD explorations, in which no CBD stones were found, and one normal ERCP. Six patients underwent postoperative ERCP, three for the removal of retained CBD stones (0.9%), all of which were cleared with a sphincterotomy. Fifteen patients had gallstone pancreatitis, six of whom had CBD stones (40%) that were cleared by ERCP. There were 33 complications (10%) and no CBD injuries.


CONCLUSIONS
The use of routine intraoperative cholangiography is discouraged in view of its low yield and the significant rate of false positive cholangiogram results.
Korman
J
J
Department of Surgery, Long Island Jewish Medical Center, New Hyde Park, New York 11040, USA.
Cosgrove
J
J
Furman
M
M
Nathan
I
I
Cohen
J
J
D000208:Acute Disease; D002758:Cholangiography / Q000706:statistics & numerical data; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000706:statistics & numerical data; D017081:Cholecystectomy, Laparoscopic / Q000706:statistics & numerical data; D002769:Cholelithiasis / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D011182:Postoperative Care