ABSTRACT
One hundred eighty five patients underwent laparoscopic cholecystectomy [LC] from July 1992 to august 1994. From this group of patients, 31 patients demonstrated preoperative risk factors for common bile duct [CBD] stones, underwent endoscopic retrograde cholangiopancreatography [ERCP] 2-5 days prior to LC. The risk factor; other than ultrasound visualization of choledochlithiasis [29%]; included history of jaundice [54.8%], history of cholangitis [29%], manifest jaundice [48.4%], elevated hepatic enzymes [71%] and dilated CBD by ultrasound [64.5%]. Serum bile acids was estimated before enoscopic stone extraction and two weeks post LC. CBD stones were identified and sphincterotomy was performed in 29 patients but stone retrival was successful in only 24 patients [82.8%]. Overall morbidity was [6.5%] represented by a patient who develoed mild pancreatitis and another who experienced endoscopic shphincterotomy-related bleeding that required surgical sphinctteroplasty. The two hours post-prandial serum bile acid [cholylglycine] level was elevated in 26 patients [83.9%] and dropped in all of them, with a percentage reduction of an average of 73.4%, two weeks post LC. We believe that this alternative method for treating choledocholithiasis is safe and effective. Also, a relatively high level of serum bile acids in cases diagnosed as chronic calcular cholecystitis could be a relative indication for further investigation to detect the potency of bile ducts. Any level above 410 ug/dl should raise the uspicion of cholestasis and reduction of the post decompression levels could be a further index of success