title: Selective use of endoscopic retrograde cholangiopancreatography to facilitate laparoscopic cholecystectomy without cholangiography. A review of 1139 consecutive cases.
abstract: BACKGROUND
  The aim of this study was to show that laparoscopic cholecystectomy can be performed safely without routine intraoperative cholangiography.
  
  
  METHODS
  We performed a retrospective analysis of 1139 consecutive patients (376 men and 763 women with an average age of 51.4 years) who underwent laparoscopic cholecystectomy between 1991 and 1999. In all, 227 patients (20%) were selected to undergo preoperative endoscopic retrograde cholangiopancreatography (ERCP) on the basis of four criteria for risk of stones.
  
  
  RESULTS
  ERCP allowed us to make a diagnosis of biliary stones in 53.3% of the selected patients. Extraction of the stones was successful in 97% of the cases. In 14% of cases, ERCP was normal; in 32.7%, some useful diagnostic information was obtained. There were three complications (pancreatitis) following endoscopy (complication rate, 1.3%). Laparoscopic cholecystectomy was successful in 92% of patients. The postoperative morbidity rate was 3.2% (major complications, 0.5%). There were no deaths. During a follow-up period ranging from 3 to 97 months, six patients (0.6%) were found to have residual biliary stones.
  
  
  CONCLUSIONS
  This study confirms the hypothesis that laparoscopic cholecystectomy can be performed safely without routine intraoperative cholangiography.
authors.affiliation: Department of General Surgery, Catholic University School of Medicine, Largo A. Gemelli, 8-00168 Rome, Italy. robertocoppola@iol.it
authors.forename: R
authors.initials: R
authors.lastname: Coppola
authors.forename: M E
authors.initials: ME
authors.lastname: Riccioni
authors.forename: S
authors.initials: S
authors.lastname: Ciletti
authors.forename: L
authors.initials: L
authors.lastname: Cosentino
authors.forename: V
authors.initials: V
authors.lastname: Ripetti
authors.forename: P
authors.initials: P
authors.lastname: Magistrelli
authors.forename: A
authors.initials: A
authors.lastname: Picciocchi
mesh_terms: D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000191:economics; D017081:Cholecystectomy, Laparoscopic / Q000191:economics; D002769:Cholelithiasis / Q000175:diagnosis / Q000191:economics / Q000601:surgery*; D005260:Female; D042882:Gallstones / Q000175:diagnosis / Q000601:surgery; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications