Synchronous laparoscopic cholecystectomy and intra-operative endoscopic retrograde cholangio-pancreatography: should it be the standard of care?

Abstract

Introduction: Up to 20 % of patients diagnosed with chronic calcular cholecystitis have concomitant CBD stones. Management included open and laparoscopic CBD exploration, endoscopic approach; pre-operative or intra-operative ERCP. Methods: This is a retrospective analysis of 120 patients who underwent laparoscopic cholecystectomy (LC) and intra-operative ERCP at Gastrointestinal surgery center, Mansoura university between 2012 and 2017. LC was done first. Intra-operative cholangiography (IOC) was attempted in all cases. Results: Median age was 32 years. Median CBD stone size was 8 mm. Median number of stones was 1 (1–3). The median operative time for both LC and ERCP was 75 minutes. Transcystic IOC was successful in 97.5% of cases where passed CBD stone was confirmed in 9 patients therefore avoiding unnecessary ERCP. We had 4 cases of failed endoscopic cannulation (3.6%), 2 of them underwent laparoscopic CBD exploration and the other 2 underwent open CBD exploration. We failed to completely clear the CBD endoscopically in 3 cases. Conclusion: LC with intra-operative ERCP is safe and feasible where combining laparoscopy and endoscopy enhances the outcomes of both.