Single-step treatment of gall bladder and bile duct stones: A combined endoscopic–laparoscopic technique

摘要: Abstract Introduction The advent of endoscopic techniques changed surgery in many regards. In the management cholelithiasis; laparoscopic cholecystectomy (LC) is today treatment choice. This has created a dilemma choledocholithiasis. Today number options exist, including sphincterotomy (ES) before LC patients with suspected common bile duct (CBD) stones, exploration (LCBDE) by transcystic approach or choledocotomy, open CBD and postoperative ERCP. A major concern regarding both pre- extraction stones (CBDS) ERCP risk development pancreatitis, also more than 10% preoperative normal. More recently alternative technique combined intraoperative ES emerging an attempt to manage cholecysto-choledocholithiasis single-step procedure. Objectives aim this work was assess one-stage operation retrograde cholangiopancreatography (LC+IO-ERCP) (ES). Patients methods study carried out on 45 gall bladder confirmed CBDS at Gastrointestinal Surgery Unit Main Alexandria University Hospital. They were treated procedure combining IO-ERCP. Laparoscopic cholangiography (IOC) confirm presence CBDS. soft-tipped guide-wire passed through cystic papilla into duodenum. papillotome inserted endoscopically over guide-wire. Endoscopic performed extracted retrieval balloon Dormia basket. surgical operating time, success rate, complications, retained CBDS, length hospital stay assessed. Results There 30 females 15 males. Their mean age 45.07+11.3 years (ranging from 27 65years). Twenty-seven had ultrasound (US) and/or MRCP. Eighteen for clinical, laboratory US basis. Conversion occurred one case due severe adhesions Calot's triangle. IOC revealed 36 patients. IO-ERCP successfully 33 endoscopically. Passage failed three Cholecystectomy completed laparoscopically 44 operative time 119+14.4min 100 150min). Minor complications No related procedure, i.e., bleeding, perforation, encountered. regained their bowel motion next day discharged after 2.55+0.89 days. None presented follow-up symptoms, signs, radiological evidence duration 9+4.07 months 3 to14 months). Conclusion current suggests that LC+IO-ERCP safe aneffective low rate post-ERCP pancreatitis. It offers another surgeons especially those who do not practice LCBDE treat single setting. However, additional studies larger patient populations are needed keeping mind limiting characteristic proximity availability settings.