management of cholelithiasis and choleocholithiasis: a combined endoscopic and laparoscopic approach with expanding risk factors

ABSTRACT

One hundred fifty seven patients underwent laparoscopic cholecystectomy from February 1992 to May 1994. From this group of patients, 31 patients demonstrated preoperative risk factors for common duct stones and underwent endoscopic retrograde cholangiopancreatography [ERCP] 1-5 days prior to L.C. The risk factors, other than ultrasound visualization of choledocholithiasis [29%], included history of jaundice [54.8%], history of cholangitis [29%], manifest jaundice [35.5%], elevated serum alkaline phosphatase and gamma glutamyltranspeptidase [45.2%] and dilated common bile duct [CBD] by ultrasound [48.4%]. Serum bile acids was estimated before endoscopic stone extraction and two weeks postlaparoscopic cholecystectomy. There were 2 ERCP failures due to periampullary diverticula. Common duct stones were identified and sphincterotomy was performed in 29 patients [100%] but stone retrieval by wire basket was successful in only 24 patients [82.8%]. The 2 hours postpr and ial serum bile acid [cholglycine] level was elevated in 25 patients [80.6%] and dropped in all of them with a percentage reduction of an average of 65%, two weeks postlaparoscopic cholecystectomy. Overall morbidity was [6.5%] represented by a patient who developed mild pancreatitis and another one who experienced endoscopic sphincterotomy-related bleeding that required surgical sphincteroplasty