A same day approach for choledocholithiasis using endoscopic stone removal followed by laparoscopic cholecystectomy: a retrospective study.
OBJECTIVE
The timing of minimally invasive approach of choledocholithiasis, using endoscopic retrograde cholangiopancreatography (ERCP) and laparoscopic cholecystectomy (LC), is challenging. The aim of the present retrospective study was to assess the feasibility and safety of endoscopic stone removal for choledocholithiasis followed by same-day LC.


METHODS
Between October 2005 and February 2007, 27 patients diagnosed with choledocholithiasis were treated with this approach. Of these patients, nine (33%) had either pancreatitis or cholangitis. The mean age of the patients was 56 years (range, 29-78). ERCP was performed in the endoscopic unit, whereas LC was performed in the theater Success rate and clinical outcome were analyzed.


RESULTS
Ninety-three percent clinical success was achieved. Two patients required conversion to opened cholecystectomy because of uncertain anatomy. There was no 30-day postoperative mortality. Two patients (7%) had postoperative complications (post-ERCP pancreatitis and superficial surgical site infection). The mean interval between the two procedures was 122 minutes (28-325). The mean operative time of ERCP was 25 minutes (15-30) and of LC was 83 minutes (30-140). The mean length of hospital stay was four days (range, 3-6).


CONCLUSIONS
The management of choledocholithiasis using endoscopic stone removal, followed by same day laparoscopic cholecystectomy, is safe and has good clinical outcomes.
Akaraviputh
Thawatchai
T
Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand. sitak@mahidol.ac.th
Rattanapan
Thitipong
T
Lohsiriwat
Varut
V
Methasate
Asada
A
Aroonpruksakul
Somkiat
S
Lohsiriwat
Darin
D
D000328:Adult; D000368:Aged; D002760:Cholangiopancreatography, Endoscopic Retrograde; D017081:Cholecystectomy, Laparoscopic; D042883:Choledocholithiasis / Q000000981:diagnostic imaging* / Q000601:surgery*; D005260:Female; D042882:Gallstones / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome