Laparoendoscopic Rendezvous: an Effective Treatment for Patients with Cholelithiasis and Choledocholithiasis

Brijendra Singh, MSMChGI, Surgery, Shahana Gupta, MS, Vk Mishra, MDDMMEDICAL, GASTROENTEROLGY, Arun Khanduri, MDDM, MEDICAL, GASTROENTEROLOGY, Alok Gupta, MDDMMEDICAL, GASTROENTEROLOGY. Regency Hospital,kanpur,india And Medical College Calcutta,india.

Introduction : There is no consensus on the optimal method of management of concomitant gallstones and common bile duct stones. However, intra operative ERCP by the ‘laparoendoscopic rendezvous’ (RV) technique is emerging as a preferred treatment option. The aim of this study is to evaluate technical feasibility and benefits of RV technique in patients with cholelithiasis and proven or strongly suspected choledocholithiasis.

Methods and Procedures : This study was carried out on 61 patients with cholelithiasis and suspected or confirmed choledocholithiasis in the Surgical Gastroenterology unit of Regency Hospital and Gastro Liver Hospital, Kanpur, India during the period 2006-2013. Laparoscopic cholecystectomy with Intraoperative ERCP by RV technique was performed in each case. The parameters assessed included antegrade papilla cannulation rate, total operative time, a timing of the postoperative return of peristaltic activity and food intake, incidence of postoperative complications especially pancreatitis and the prevalence of retained CBD stones.

Results: The technique was successful in 95.8% patients. The mean operating time was 75 minutes. There was no mortality and no postoperative complications e.g. pancreatitis, bleeding or perforation. Six patients complained of postoperative abdominal bloating and pain over tip of the right shoulder. Return of intestinal peristaltic activity was noted in all patients within 24 hours. The mean duration of hospitalization was 2 days. There were no retained stones in this series with a CBD clearance rate of 100%.

Conclusion: The rendezvous procedure is a safe and effective treatment option for the management of concomitant cholelithiasis and choledocholithiasis, especially in cases with failed ERCP.

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