A Same Day Approach for Choledocholithiasis Using Endoscopic Stone Removal Followed by Laparoscopic Cholecystectomy: A Retrospective Study
Thawatchai Akaraviputh MD*, Thitipong Rattanapan MD*, Varut Lohsiriwat MD*, Asada Methasate MD, PhD*, Somkiat Aroonpruksakul MD**, Darin Lohsiriwat MD*
Affiliation : * Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand ** Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Objective : The timing of minimally invasive approach of choledocholithiasis, using endoscopic retrograde
cholangiopancreatography (ERCP) and laparoscopic cholecystectomy (LC), is challenging. The aim of the
present retrospective study was to assess the feasibility and safety of endoscopic stone removal for choledocho-
lithiasis followed by same-day LC.
Material and Method: Between October 2005 and February 2007, 27 patients diagnosed with choledocho-
lithiasis were treated with this approach. Of these patients, nine (33%) had either pancreatitis or cholangitis.
The mean age of the patients was 56 years (range, 29-78). ERCP was performed in the endoscopic unit,
whereas LC was performed in the theater. Success rate and clinical outcome were analyzed.
Results : Ninety-three percent clinical success was achieved. Two patients required conversion to opened
cholecystectomy because of uncertain anatomy. There was no 30-day postoperative mortality. Two patients
(7%) had postoperative complications (post-ERCP pancreatitis and superficial surgical site infection). The
mean interval between the two procedures was 122 minutes (28-325). The mean operative time of ERCP was
25 minutes (15-30) and of LC was 83 minutes (30-140). The mean length of hospital stay was four days (range,
3-6).
Conclusion : The management of choledocholithiasis using endoscopic stone removal, followed by same day
laparoscopic cholecystectomy, is safe and has good clinical outcomes.
Keywords : Choledocholithiasis, ERCP, Laparoscopic cholecystectomy
