title: Preoperative selective endoscopic retrograde cholangiopancreatography and laparoscopic cholecystectomy without cholangiography.
abstract: The aim of this study was to show that laparoscopic cholecystectomy can be performed safely without routine intraoperative cholangiography. We performed a retrospective analysis of 1750 consecutive patients (1170 females and 580 males with a mean age of 51 years) who underwent laparoscopic cholecystectomy between January 1991 and January 2000. In all, 193 patients (11%) were selected to undergo preoperative endoscopic retrograde cholangiopancreatography (ERCP) on the basis of several criteria for risk of stones. No patients underwent intraoperative cholangiography. ERCP allowed us to make a diagnosis of biliary stones in 62.7% (121 cases). Extraction of the stones was successful in 96% of the cases. In 12% of cases ERCP findings were normal; in the remaining 26.3%, useful diagnostic information was obtained. There were three complications (bleeding and pancreatitis) after endoscopy (complication rate: 1.5%). Laparoscopic cholecystectomy was successful in 92.7% of patients, with a postoperative morbidity rate of 3% (0.5% of major complications). There were no deaths in this series. During a mean follow-up of 60 months (range, 12-120), 7 patients (0.43%) were found to have residual biliary stones (5 had not had preoperative ERCP). The study confirms the hypothesis that laparoscopic cholecystectomy can be safely performed without routine intraoperative cholangiography, with selective use of preoperative ERCP.
authors.affiliation: Department of Surgery and Operative Unit of Endoscopy, San Gerardo Hospital, II University of Milan, Bicocca, Monza, Italy. fabriziorom@hotmail.com
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Romano
authors.forename: Claudio M
authors.initials: CM
authors.lastname: Franciosi
authors.forename: Roberto
authors.initials: R
authors.lastname: Caprotti
authors.forename: Sergio
authors.initials: S
authors.lastname: De Fina
authors.forename: Aldo
authors.initials: A
authors.lastname: Lomazzi
authors.forename: Giovanni
authors.initials: G
authors.lastname: Colombo
authors.forename: Giorgio
authors.initials: G
authors.lastname: Visintini
authors.forename: Franco
authors.initials: F
authors.lastname: Uggeri
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D002758:Cholangiography; D002760:Cholangiopancreatography, Endoscopic Retrograde; D017081:Cholecystectomy, Laparoscopic; D042882:Gallstones / Q000601:surgery*; D006801:Humans; D007432:Intraoperative Period; D008875:Middle Aged