Selective endoscopic retrograde cholangiography prior to laparoscopic cholecystectomy for gallstones.
Publication/Presentation Date
7-1-1999
Abstract
BACKGROUND: To assess the outcome of endoscopic retrograde cholangiography (ERC) before laparoscopic cholecystectomy (LC) for symptomatic gallbladder and suspected duct stones.
METHODS: During 3 years, one or more of four criteria led to ERC: jaundice, choledocus >8 mm, cholestasis, and severe biliary pancreatitis. Endoscopic extraction (ESE) of ductal stones was attempted before LC.
RESULTS: In all, 990 patients were prospectively included. There were no exclusions. There were no deaths. A multivariate logistic regression analysis identified jaundice (P = 0.001), pancreatitis (P = 0.001), and cholestasis (P = 0.001) as statistically significant predictors of ductal stones. Choledocus >8 mm was not a significant predictor (P = 0.12). A total of 155 (16%) patients underwent ERC for suspected stones: 21 of 155 (13%) patients had no stones; and 6 of 134 (4%) patients had stone impaction cleared at open surgery. ERC clearance rate was 95% (128 of 134). LC was performed in 149 of 155 patients after a median interval of 3 days (range 1 to 7). Morbidity rates were 3% (4 of 134), 2% (3 of 149), and nil (0 of 6) after ESE, LC, or open surgery, respectively. Median hospital stay was 11 days. A total of 835 patients underwent LC with a 1.5% complication rate. Laparoscopic fluoro-cholangiography showed < or =3 mm-sized stones in 10 of 835 (1.2%) patients. No stones were reported at a median follow-up of 4 months including 990 patients.
CONCLUSIONS: Ninety-five percent of patients with ductal stones can be successfully and safely managed by ERC prior to LC.
Volume
178
Issue
1
First Page
46
Last Page
49
ISSN
0002-9610
Published In/Presented At
Bergamaschi, R., Tuech, J. J., Braconier, L., Walsøe, H. K., Mårvik, R., Boyet, J., & Arnaud, J. P. (1999). Selective endoscopic retrograde cholangiography prior to laparoscopic cholecystectomy for gallstones. American journal of surgery, 178(1), 46–49. https://doi.org/10.1016/s0002-9610(99)00110-5
Disciplines
Medicine and Health Sciences
PubMedID
10456702
Department(s)
Department of Surgery
Document Type
Article