ERCP and Laparoscopic Cholecystectomy : Stone, Sphincterotomy and Stenting

Towhidul Alam, Prof of Surgery. Bangabandhu Sheik Mujib Medical University

Introduction:
ERCP is a useful adjunct in the management of patients undergoing laparoscopic cholecystectomy (LC) who have common duct stones. It is also necessary for the management of residual stones & complications after LC.

Methods:
The study was conducted during January 2003 to August 2010 in the Department of surgery BSMMU and in Crescent Gastroliver Hospital of Dhaka. It included 228 patients in whom ERCP were necessary before and after LC. Out of 228 cases 142 patients had stones both in bile duct and gall bladder so ERCP was needed in all those cases prior to Laparoscopic cholecystectomy. Another 60 patients with retained CBD stones after LC were managed by ERCP. Twenty six patients with complications following LC also needed the help of ERCP.

Results:
Out of 142 cases with stones both in bile duct & gallbladder, endoscopic stone removal from CBD before LC was successful in 135(95%) patients, remaining 7 cases needed open surgery. In another 60 patients with residual stone in common duct after LC, endoscopic stone extraction was successful in all cases. Twenty six patients with complications following LC offered ERCP & it was successful in the management of 14 cases, rest of the twdlvd patients ERCP helped only in the diagnosis. One of the patients with major type of injury ultimately died. Patients where therapeutic ERCP was successful were discharged on 2nd or 3rd day of the procedure.

Conclusions:
For the management of bile duct stone both before and after laparoscopic cholecystectomy ERCP is a well established procedure, whereas laparoscopic CBD exploration is still in its infancy and expertise is limited to a very few centers. Similarly ERCP is the definitive choice of procedure for the management of bile duct injury following LC.


Session: Poster
Program Number: P362
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