title: Single-stage treatment with intraoperative ERCP: management of patients with possible choledocholithiasis and gallbladder in situ in a non-tertiary Spanish hospital.
abstract: BACKGROUND
  The best way to reduce endoscopic retrograde cholangiopancreatography (ERCP) complications is not to perform it if it is unnecessary. Both intraoperative and postoperative ERCP rely on use of intraoperative cholangiography as a final diagnostic test for choledocholithiasis (CLD) whenever clinical data are unable to rule out CLD. Intraoperative ERCP could become a therapeutic option when a previous preoperative ERCP fails. We present our experience with intraoperative ERCP.
  
  
  METHODS
  This is a descriptive and prospective study of a cohort of 82 patients with moderate risk of CLD. They were operated on by laparoscopic cholecystectomy with intraoperative cholangiography (IOC). We performed intraoperative ERCP using the rendezvous technique.
  
  
  RESULTS
  Thirty-six out of 82 patients had an abnormal IOC study. Mean age was 58.7 years (standard deviation, SD 16.6, 25-83 years), and 60.6% were females. Ultrasound study showed that 51.4% of patients had a dilated bile duct. Magnetic resonance cholangiography (MRC) was performed on three patients (8.3%). The success rate of intraoperative ERCP was 88.2%. Three out of the 36 patients (8.8%) had ERCP complications [2 mild papillary bleeding (5.8%), 1 acute pancreatitis (2.9%)]. The rate of conversion to open surgery was 5% with a surgical complications rate of 4% [one injured duct and two surgical bleeding which required re-operation (2.5%)]. There were no mortalities. Four patients (11.1%) needed post-surgical ERCP, with a residual CLD rate of 5.6% (two patients) in the postoperative period. Mean surgical time was 181 min (SD 60, 75-345 min). Mean hospital stay was 6.2 days (SD 4.7, 2-24 days).
  
  
  CONCLUSIONS
  Intraoperative ERCP is an option to prevent performing ERCP unnecessarily on patients with moderate risk of CLD not confirmed using appropriate radiological studies. It can resolve the biliary disease in a single step with a similar success rate to standard ERCP, but with low morbidity, especially of acute pancreatitis. The residual CLD rate is also very low.
authors.affiliation: Gastroenterology Department, Hospital Severo Ochoa, Leganés, Madrid, Spain. lrabagot@gmail.com
authors.forename: L R
authors.initials: LR
authors.lastname: Rábago
authors.forename: I
authors.initials: I
authors.lastname: Chico
authors.forename: D
authors.initials: D
authors.lastname: Collado
authors.forename: A
authors.initials: A
authors.lastname: Olivares
authors.forename: A
authors.initials: A
authors.lastname: Ortega
authors.forename: E
authors.initials: E
authors.lastname: Quintanilla
authors.forename: M
authors.initials: M
authors.lastname: Delgado
authors.forename: J L
authors.initials: JL
authors.lastname: Castro
authors.forename: R
authors.initials: R
authors.lastname: Llorente
authors.forename: J
authors.initials: J
authors.lastname: Vazquez Echarri
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods*; D042883:Choledocholithiasis / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D005704:Gallbladder / Q000601:surgery*; D006801:Humans; D007430:Intraoperative Care / Q000379:methods*; D010535:Laparoscopy / Q000379:methods; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D013030:Spain; D016896:Treatment Outcome
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