A total of 307 consecutive patients with symptomatic gallstones were admitted for cholecystectomy. Two hundred seventy patients (88%) were considered suitable for laparoscopic cholecystectomy. Forty-two of these (17%) were admitted on an emergency basis. The procedure was accomplished successfully in 246 patients (91%), while in the remaining 24 patients (9%), the attempt had to be abandoned and converted to open cholecystectomy. Postoperative complications, mostly minor, occurred in 22 patients (9%). Suspected common bile duct stones were treated with endoscopic retrograde cholangiopancreatography (ERCP) prior to surgery. The mean operative time was 82 minutes and 70% of the patients were discharged home within 48 hours after surgery and more than 90% were sent home by the third postoperative day. The results suggest that laparoscopic cholecystectomy is feasible for the majority of patients with symptomatic gallstones.

This study is to evaluate the need for preoperative cholangiography during laparoscopic cholecystectomy when endoscopic retrograde cholangiopancreatography (ERCP) is available. Over a period of four years, 1105 consecutive patients had laparoscopic cholecystectomy. All patients, in addition to their clinical assessment, had routine liver function tests (LFTs) and ultrasound (US) examination of the biliary tract. Preoperative ERCP was performed (diagnostic and/or therapeutic) in 107 (9.6%) of the patients. The indications for ERCP were one or more of the following: 1) abnormal liver function test, 74 patients; 2) jaundice, 37 patients; 3) common bile duct (CBD) stone seen in US, 36 patients, and/or CBD dilatation, 46 patients; and 4) pancreatitis, 20 patients. In 41 out of 107 (38%) patients, CBD stones were present and cleared endoscopically. Postoperative ERCP was necessary in eight patients: to remove retained stones in the CBD (two patients), to stop bile leak (two patients), and to investigate the persistent abnormal LFTs in the remaining patients. The number of patients who had evidence of retained CBD stone following laparoscopic cholecystectomy was only two. In both patients, endoscopic removal was successful. Despite the rapid development and acceptance of laparoscopic cholecystectomy (LC), there is still no consensus among clinicians regarding the timing, method of imaging and the subsequent treatment of common bile duct (CBD) stones.1 Proponents of routine intraoperative cholangiography (IOC) claim that their practice lowers the risk of CBD injuries and leads to fewer retained bile duct stones.1,2 The disadvantages of routine IOC include increase in costs, operative time and false positive findings, leading to unnecessary efforts to clear the CBD stones.3 This leads many other surgeons to propose that IOC should be selective. 4,5 This study reviews an alternative approach to the CBD imaging in LC. Endoscopic retrograde cholangiopancreatography (ERCP) was utilized in the management of selected patients who were thought to have choledocholithiasis. The experience of using ERCP in patients undergoing laparoscopic cholecystectomy in Security Forces Hospital is reviewed. Patients and MethodsBetween October 1991 and September 1995 (four years), 1105 consecutive patients had laparoscopic cholecystectomy. All patients, whether admitted electively or urgently, were included in this study. The clinician recorded all patient data, including history, clinical examination, baseline investigation, and liver function tests (LFTs). Ultrasound of the abdomen was performed on all patients and, when indicated, further tests were performed. Patients who had a history of pancreatitis, biliary dilatation or CBD stones observed on ultrasound were scheduled for preoperative ERCP. Patients with upper abnormal obstructive LFTs (with serum bilirubin and alkaline phosphatase more than double the normal) presenting with upper abdominal pain were also scheduled for preoperative ERCP. Common bile duct stone extraction was performed ...