Current management of common bile duct stones: is there a role for laparoscopic cholecystectomy and intraoperative endoscopic retrograde cholangiopancreatography as a single-stage procedure?

BACKGROUND: Although laparoscopic cholecystectomy (LC) and therapeutic endoscopic retrograde cholangiopancreatography (ERCP) have revolutionized the management of secondary common bile duct (CBD) stones, the use of these modalities as a single-stage procedure remains controversial. The aim of this study is to determine whether LC and intraoperative ERCP as a single procedure has any advantages to LC and either preoperative or postoperative therapeutic ERCP performed in 2 stages.

METHODS: A retrospective 5-year review involved all patients undergoing both LC and ERCP for management of CBD stones from January 1997 to December 2001. Patients were categorized into 3 groups: (1) preoperative ERCP, followed by LC (ERCP then LC); (2) LC, followed by postoperative ERCP (LC then ERCP); and (3) LC with intraoperative ERCP as a single procedure (LC/ERCP).

RESULTS: Sixty-seven patients were treated for secondary CBD stones. Forty-three patients underwent ERCP then LC, 10 underwent LC then ERCP, and 14 patients underwent LC/ERCP. There were no differences among the groups in terms of patient demographics or overall complication rates. CBD access and stone clearance was achieved in all 67 (100%) patients, with 1 mild ERCP-related complication in the ERCP-then-LC group. Overall complication rates, hospital length of stay, and total hospital charges were not statistically different among the 3 groups.

CONCLUSION: Single-stage LC/ERCP provides efficacious therapy for CBD stones and may be beneficial in select patients who may not tolerate a second anesthetic procedure.