The development of
laparoscopic cholecystectomy has rekindled the issue of management of
choledocholithiasis. A number of options exist including pre or postoperative
endoscopic sphincterotomy (ERCP-ES), laparoscopic common duct exploration or open common duct exploration. We present here our experience with the management of
choledocholithiasis in patients treated with
laparoscopic cholecystectomy. From January 1991 to January 1995, 900 patients underwent
laparoscopic cholecystectomy. 71 ERCP were carried out in 71 patients with suspicion or evidence of
choledocholithiasis. Common duct stones were detected in 44 patients. Preoperative ERCP was done in 56 patients, with suspicion of
choledocholithiasis, based on clinical, laboratory or ultrasonographic findings. 29 of these patients (51.7%) had common duct stones, that were successfully removed by
endoscopic sphincterotomy. One patient suffered mild
pancreatitis and a second one had transient
hyperamylasemia. Postoperative ERCP was performed in 15 patients. Indications for ERCP were the evidence of common duct stones in intraoperative cholangiography in 7 cases, and clinical or laboratory suspicion of
choledocholithiasis, 3 months to 3 years after
laparoscopic cholecystectomy. Stones were detected in 100% of the patients. In 11 patients (73.3%), the stones were extracted by
endoscopic sphincterotomy and 4 patients underwent open common duct exploration. Two patients had transient
hyperamylasemia. ERCP is a safe and effective method for detection and treatment of common duct stones. ERCP prior to
laparoscopic cholecystectomy in patients suspected of having
choledocholithiasis, is safe and offers with good results. Rutinary intraoperative cholangiography is recommended, for the detection of unsuspected
choledocholithiasis and as an effective treatment (postoperative-ERCP, open or laparoscopic common duct exploration) can be chosen depending on surgeon's skills and patient's characteristics.