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Abstract
laparoscopic cholecystectomy has become the first choice for symptomatic gallstone, but there are no agreement about the therapy of supposed synchronus choledocholithiasis.
Choledocholithiasis, if left untreated, can lead to significant morbidity and mortality. The managment of such problem has progressed tremendously but controversy still exists as to ideal managment, laparoscopic (CBDE) or endoscopic retrograde cholangiopancreatography with (ES).
Although the efficacy of laparoscopic (CBDE) has been documented by many studies, it is still not routinely used for the managment of (CBDs). This approach faces the problem of longer operative time and is therefore unsuitable for eldery and high risk patients. It requires experience in advanced laparoscopy and many surgeons performing (LC) are still not confident in (LCBDE). This method also requires expensive and sophisticated equipment that is unavailable in many places. (ERCP) has now challenged the laparoscopic approach of managing (CBD) stones which was initiated after the introduction of laparoscopic cholecystectomy by Dubois from France in 1989.
Endoscopic sphincterotomy (ES) has become the gold standard non operative modality for the removal of (CBDs). Morbidity is 2%-10%. Immdiate complication include bleeding, cholangitis, pancreatitis, duodenal perforation, but many of these can be prevented by using various tools, including an alternating coagulating and cutting diathermy unit, routine biliary stenting, frequant use of guide wires to avoid precutting and mechnical lithtripsy.
The timing of ERCP with laparoscopic cholecystectomy has many modalities it may be preoperative , post operative , or intraoperative
Each modality has advantages and disadvantages.
This study was designed to compare the complications of same sitting or intraoperative ERCP during laparoscopic cholecystectomy (group I) and that of ERCP which was followed two weeks later by laparoscopic cholecystectomy (group II) in patients with cholecysto-choledocho-lithiasis.
By comparing both groups ;
The demographic data of patients , the presenting manifestations and the associated medical disease are more or less the same in both groups
there was no mortality in both groups , no conversion to open cholecystectomy ,and no injury to important structures .
group I shows one case of intraoperative bleeding from gall bladder bed which controlled intraoperativly by coagulation diathermy, one case of post operative collection in hepatorenal .
group II shows a case of Cholangitis and another case of newly passed stone , there is no difference between both groups regarding operative time , but there is significant difference between both groups regarding hospital stay time and financial cost of the procedures more with group II.