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COMMON BILE DUCT STONE TREATED BY SIMULTANEOUS LAPAROSCOPIC AND ENDOSCOPIC RENDEZVOUS APPROACH DURING CHOLECYSTECTOMY: ANALYSIS OF 313 CONSECUTIVE PATIENTS
Hugo Richter*1,2, Eduardo A. Vega1, Carlos Harz1,3, Sergio Fuenzalida2, Enrique Waugh3, Luis A. Montero1, Max E. Buchheister3, Hernan De La Fuente3, Claudio Navarrete1,3
1Endoscopic Surgery, Clinica Santa Maria, Santiago, Region Metropolitana, Chile; 2Endoscopic Surgery, Pontificie Universidad Catolica de Chile, Santiago, Region Metropolitana, Chile; 3Gastrointestinal Surgery, Clinica Santa Maria, Santiago, Region Metropolitana, Chile
Background: Intraoperative endoscopic retrograde cholangiopancreatography (IO-ERCP) with laparoscopic rendezvous has been gaining wide acceptance among surgeons for the treatment of common bile duct stone (CBDS) associated to gallbladder disease. It provides a single-procedure solution and it seems to lower the rate of complications of ERCP because “over the wire” direct cannulation of the papilla.
Patients and Method: This is a retrospective cohort study of 313 consecutive patients treated at a single center between 2008 and Sept 2016. Inclusion criteria were elective and emergency patients with cholelithiasis and simultaneous CBDS, diagnosed by ultrasound, MRI or intraoperative cholangiography (IOC). All were treated by laparoscopic cholecystectomy and IO-ERCP as needed.
Results: We treated 313 patients (189 female), mean age 47.5 (16-90). A successful rendezvous and common bile duct (CBD) stone clearance was achieved in 297 (96%) of patients. The rate of conversion to open surgery was 1.3% (4 patients). The main complications of IO-ERCP were: post-sphincterotomy bleeding in 2 patients (0.6%) and mild acute pancreatitis in 1 patient (0.3%). The laparoscopic cholecystectomy complications were: hemoperitoneum in 1 patient, and one partial bile duct injury in another patient. There were no mortalities in this series. Mean procedure time was 85 min. Mean length of hospital stay was 2 days.
Conclusion: IO-ERCP during cholecystectomy allows a high rate of CBDS clearance, a short hospital stay and low morbidity rate, in a single procedure for cholelithiasis and choledocholithiasis with no mortality.
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