ERCP in the era of laparoscopic biliary surgery: experience with 407 patients

BACKGROUND: The combined endoscopic and laparoscopic treatment of biliary stones is now highly debated, especially as regards possible complications compared to one-step laparoscopic treatment. METHODS: This study analyzes 407 cases (116 males, 291 females, average age 49 years, range 2-87) observed in the period from May 1991 to July 1994. All patients were evaluated preoperatively for the presence of biliary stones. Considering clinical presentation, blood analysis, ultrasonography, and medical history, 99 patients (24%) were selected for preoperative endoscopic retrograde cholangiopancreatography (ERCP). One patient refused preoperative ERCP. RESULTS: Thirty-nine patients (40%) were found to have biliary stones and were submitted to therapeutic endoscopic sphincterotomy (ES). Endoscopic clearance of the bile ducts was achieved in all patients, with one complication (pancreatitis). In performing laparoscopic cholecystectomy, no technical difficulties could be attributed to ERCP, nor were there any conversions in patients who had had preoperative ERCP. Average postoperative hospital stay was 2.5 days. During a follow-up period of from 2 to 39 months, we diagnosed three patients (0.7%) with symptomatic residual stones. They were submitted to successful ERCP and extraction of the stones. CONCLUSIONS: We conclude that ERCP offers an accurate preoperative selection of patients, allows for effective planning of treatment, and simplifies laparoscopic surgery.