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. 1996 Nov-Dec;43(12):1484-91.

Preoperative endoscopic retrograde cholangiopancreatography: therapeutic impact in a general population of patients needing a cholecystectomy

C H Huynh  1 , J Van de Stadt, J Devière, A Mehdi, I el Nakadi, M Cremer, J P Lambilliotte, M Gelin
Affiliations
  • PMID: 8975953

Preoperative endoscopic retrograde cholangiopancreatography: therapeutic impact in a general population of patients needing a cholecystectomy

C H Huynh et al. Hepatogastroenterology. 1996 Nov-Dec.

Abstract

Background/aims: The place of endoscopic retrograde cholangiopancreatography (ERCP) before open or laparoscopic cholecystectomy remains controversial. Most of the reports study highly selected series of patients and therefore do not give a survey of the actual situation in a general population. We describe here the therapeutic impact of preoperative ERCP in a continuous cohort of patients needing a cholecystectomy.

Material and methods: Data concerning a 2-year continuous and unselected series of 452 patients undergoing cholecystectomy were evaluated.

Results: Two hundred ninety-three patients (65%) presented with a chronic symptomatic biliary lithiasis and 159 patients (35%) with a complicated biliary lithiasis. A preoperative ERCP was performed in 206 patients, all presenting with a suspicion of associated lithiasis of the common bile duct (CBD). An endoscopic sphincterotomy was performed in 106 patients: 44 patients presented with CBD stones (9.7%), all successfully cleared by endoscopy. Laparoscopic cholecystectomy has been attempted in 367 patients (81%) and successfully performed in 333 patients (74%). Laparotomy as a first-choice procedure was performed in 85 patients (19%). Surgical choledochotomy was never performed. Postoperative ERCP was needed in 4 patients (0.88%) and in only 1 of them for a retained CBD stone (0.22%).

Conclusions: In a continuous series of patients needing a cholecystectomy, preoperative ERCP was performed on the basis of suspected CBD disorders. It allows CBD stone detection and extraction in almost 10% of the patients and avoids peroperative CBD exploration, with a very low rate of retained stones after surgery. The association of preoperative ERCP with subsequent laparoscopic cholecystectomy (when feasible) offers the patient a quick recovery and a short hospital stay.

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