Published online Jan 14, 2015. doi: 10.3748/wjg.v21.i2.609
Peer-review started: May 16, 2014
First decision: June 18, 2014
Revised: June 22, 2014
Accepted: August 28, 2014
Article in press: August 28, 2014
Published online: January 14, 2015
AIM: To evaluate the efficacy of intraoperative endoscopic retrograde cholangio-pancreatography (ERCP) combined with laparoscopic cholecystectomy (LC) for patients with gall bladder stones (GS) and common bile duct stones (CBDS).
METHODS: Patients treated for GS with CBDS were included. LC and intraoperative transcystic cholangiogram (TCC) were performed in most of the cases. Intraoperative ERCP was done for cases with proven CBDS.
RESULTS: Eighty patients who had GS with CBDS were included. LC was successful in all cases. Intraoperative TCC revealed passed CBD stones in 4 cases so intraoperative ERCP was performed only in 76 patients. Intraoperative ERCP showed dilated CBD with stones in 64 cases (84.2%) where removal of stones were successful; passed stones in 6 cases (7.9%); short lower end stricture with small stones present in two cases (2.6%) which were treated by removal of stones with stent insertion; long stricture lower 1/3 CBD in one case (1.3%) which was treated by open hepaticojejunostomy; and one case (1.3%) was proved to be ampullary carcinoma and whipple’s operation was scheduled.
CONCLUSION: The hepatobiliary surgeon should be trained on ERCP as the third hand to expand his field of therapeutic options.
Core tip: The incidence of common bile duct stones (CBDS) in patents with gall bladder stones (GS) varies between 7% and 20%. Management of CBDS is changing with advances in endoscopic techniques in many regards. Laparoscopic cholecystectomy is the gold standard in treating GS. This has created controversies in the management of CBDS. The hepatobiliary surgeon should be trained in endoscopic retrograde cholangio-pancreatography as the third hand to expand his field of therapeutic options.