Current management of common bile duct stones: is there a role for laparoscopic cholecystectomy and intraoperative endoscopic retrograde cholangiopancreatography as a single-stage procedure?
BACKGROUND
Although laparoscopic cholecystectomy (LC) and therapeutic endoscopic retrograde cholangiopancreatography (ERCP) have revolutionized the management of secondary common bile duct (CBD) stones, the use of these modalities as a single-stage procedure remains controversial. The aim of this study is to determine whether LC and intraoperative ERCP as a single procedure has any advantages to LC and either preoperative or postoperative therapeutic ERCP performed in 2 stages.


METHODS
A retrospective 5-year review involved all patients undergoing both LC and ERCP for management of CBD stones from January 1997 to December 2001. Patients were categorized into 3 groups: (1) preoperative ERCP, followed by LC (ERCP then LC); (2) LC, followed by postoperative ERCP (LC then ERCP); and (3) LC with intraoperative ERCP as a single procedure (LC/ERCP).


RESULTS
Sixty-seven patients were treated for secondary CBD stones. Forty-three patients underwent ERCP then LC, 10 underwent LC then ERCP, and 14 patients underwent LC/ERCP. There were no differences among the groups in terms of patient demographics or overall complication rates. CBD access and stone clearance was achieved in all 67 (100%) patients, with 1 mild ERCP-related complication in the ERCP-then-LC group. Overall complication rates, hospital length of stay, and total hospital charges were not statistically different among the 3 groups.


CONCLUSIONS
Single-stage LC/ERCP provides efficacious therapy for CBD stones and may be beneficial in select patients who may not tolerate a second anesthetic procedure.
Wright
Byron E
BE
Department of Surgery and Division of Gastroenterology, Hennepin County Medical Center, Minneapolis, Minn, USA.
Freeman
Martin L
ML
Cumming
John K
JK
Quickel
Robert R
RR
Mandal
Aloke K
AK
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000410:Alanine Transaminase / Q000097:blood; D000469:Alkaline Phosphatase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D001663:Bilirubin / Q000097:blood; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002763:Cholecystectomy / Q000379:methods*; D002769:Cholelithiasis / Q000601:surgery*; D003131:Combined Modality Therapy; D005006:Ethnicity; D005260:Female; D042882:Gallstones / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome
D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D000469:Alkaline Phosphatase; D001663:Bilirubin