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Intraoperative ERCP for management of cholecystocholedocholithiasis



The introduction of minimally invasive techniques in management of biliary problems added new procedures for treating patients with cholecystocholedocholithiasis (CCL). This study presents the results of intraoperative ERCP (IOERCP) during LC as a single-session minimally invasive procedure for management of patients who have preoperatively diagnosed CBD stones.


The database of patients presented to our center by CCL between October 2007 and December 2015 who were treated by LC and IOERCP was collected and analyzed. CBD stones were diagnosed using clinical data, laboratory tests and abdominal sonogram. MRCP was requested for doubtful cases. In the first cases ERCP was done using rendezvous technique, but in late cases standard ERCP immediately after completion of LC under the same anesthesia was used. Preoperative, intraoperative and postoperative data were recorded, analyzed and reported. Data reported include success/failure rate, complications, conversion to open surgery, operative details and incidence of residual CBD stones.


The study was conducted on 346 patients who had CCL. The mean age was 34.7 years, and 298 of them were females. The most common presentation was abdominal pain (98.5 %) and jaundice (64.9 %). Fifteen patients were excluded, and IOERCP was not done due to negative IOC results in 10 patients and conversion to open surgery in 5 patients. IOERCP was tried in the remaining 331 patients. The mean operative time was 55 min, and the mean hospital stay was 2.4 days. Major complications had been reported in 13/323 patients (4.0 %). Failure of CBD clearance was reported in 8 patients (2.4 %) with a success rate of 97.6 %. Thirty-day follow-up was possible in 142 patients, and there was a residual CBD stone in one patient and wound infection in another one.


IOERCP during LC is a safe and effective option for management of CCL.

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  1. 1.

    Costi R, Mazzeo A, Tartamella F et al (2010) Cholecystocholedocholithiasis: a case–control study comparing the short- and long-term outcomes for a “laparoscopy-first” attitude with the outcome for sequential treatment. Surg Endosc 24:51–62

  2. 2.

    Martin DJ, Vernon DR, Toouli J (2006) Surgical versus endoscopic treatment of bile duct stones. Cochrane Database Syst Rev (2):CD003327. doi:10.1002/14651858.CD003327.pub2

  3. 3.

    Möller M, Gustafsson U, Rasmussen F et al (2014) Natural course vs interventions to clear common bile duct stones: data from the Swedish Registry for Gallstone Surgery and Endoscopic Retrograde Cholangiopancreatography (GallRiks). JAMA Surg 149(10):1008–1013

  4. 4.

    Scientific Committee of the European Association for Endoscopic (1998) Surgery (E.A.E.S.). Diagnosis and treatment of common bile duct stones (CBDS): results of a consensus development conference. Surg Endosc 12:856–864

  5. 5.

    Phillips EH, Toouli J, Pitt HA et al (2008) Treatment of common bile duct stones discovered during cholecystectomy. J Gastrointest Surg 12:624–628

  6. 6.

    Ghazal AH, Sorour MA, El-Riwini M et al (2009) Single-step treatment of gallbladder and bile duct stones: a combined endoscopic–laparoscopic technique. Int J Surg 7:338–346

  7. 7.

    ElGeidie AA, ElEbidy GK, Naeem YM (2011) Preoperative versus intraoperative endoscopic sphincterotomy for management of common bile duct stones. Surg Endosc 25:1230–1237

  8. 8.

    Rhodes M, Sussman L, Cohen L et al (1998) Randomised trial of laparoscopic exploration of common bile duct versus postoperative endoscopic retrograde cholangiography for common bile duct stones. Lancet 351:159–161

  9. 9.

    Nathanson LK, O’Rourke NA, Martin IJ et al (2005) Postoperative ERCP versus laparoscopic choledochotomy for clearance of selected bile duct calculi: a randomized trial. Ann Surg 242:188–192

  10. 10.

    Chander J, Vindal A, Lal P et al (2011) Laparoscopic management of CBD stones: an Indian experience. Surg Endosc 25:172–181

  11. 11.

    Rábago LR, Ortega A, Chico I et al (2011) Intraoperative ERCP: what role does it have in the era of laparoscopic cholecystectomy? World J Gastrointest Endosc 3:248–255

  12. 12.

    Baucom RB, Feurer ID, Shelton JS et al (2015) Surgeons, ERCP, and laparoscopic common bile duct exploration: do we need a standard approach for common bile duct stones? Surg Endosc 30:414–423

  13. 13.

    De Palma GD, Angrisani L, Lorenzo M et al (1996) Laparoscopic cholecystectomy (LC), intraoperative endoscopic sphincterotomy (ES), and common bile duct stones (CBDS) extraction for management of patients with cholecystocholedocholithiasis. Surg Endosc 10:649–652

  14. 14.

    Deslandres E, Gagner M, Pomp A et al (1993) Intraoperative endoscopic sphincterotomy for common bile duct stones during laparoscopic cholecystectomy. Gastrointest Endosc 39:54–58

  15. 15.

    Cavina E, Franceschi M, Sidoti F et al (1998) Laparo-endoscopic “rendezvous”: a new technique in the choledocholithiasis treatment. Hepatogastroenterology 45:1430–1435

  16. 16.

    Brady PG, Pinkas H, Pencev D (1996) Endoscopic retrograde cholangiopancreatography and laparoscopic cholecystectomy. Dig Dis 14:371–781

  17. 17.

    El-Geidie AA (2011) Laparoendoscopic management of concomitant gallbladder stones and common bile duct stones: what is the best technique? Surg Laparosc Endosc Percutan Tech 21:282–287

  18. 18.

    Banks PA, Bollen TL, Dervenis C (2013) Classification of acute pancreatitis: revision of the Atlanta classification and definitions by international consensus. Gut 62:102–111

  19. 19.

    Cotton PB, Lehman G, Vennes J (1991) Endoscopic sphincterotomy complications and their management: an attempt at consensus. Gastrointest Endosc 37:383–393

  20. 20.

    Zhu HY, Xu M, Shen HJ et al (2015) A meta-analysis of single-stage versus two-stage management for concomitant gallstones and common bile duct stones. Clin Res Hepatol Gastroenterol 39:584–593

  21. 21.

    Alexakis N, Connor S (2012) Meta-analysis of one- vs. two-stage laparoscopic/endoscopic management of common bile duct stones. HPB (Oxford) 14:254–259

  22. 22.

    Nagaraja V, Eslick GD, Cox MR (2014) Systematic review and meta-analysis of minimally invasive techniques for the management of cholecysto-choledocholithiasis. J Hepatobiliary Pancreat Sci 21:896–901

  23. 23.

    Stoker ME, Leveillee RJ, McCann JC Jr et al (1991) Laparoscopic common bile duct exploration. J Laparoendosc Surg 1:287–293

  24. 24.

    Williams EJ, Green J, Beckingham I, Parks R et al (2008) Guidelines on the management of common bile duct stones (CBDS). Gut 57:1004–1021

  25. 25.

    Centre National Clinical Guideline (2014) Gallstone disease: diagnosis and management of cholelithiasis, cholecystitis and choledocholithiasis. National Clinical Guideline Centre, London

  26. 26.

    Puhalla H, Flint N, O’Rourke N (2015) Surgery for common bile duct stones—a lost surgical skill; still worthwhile in the minimally invasive century? Langenbecks Arch Surg 400:119–127

  27. 27.

    Bencini L, Tommasi C, Manetti R et al (2014) Modern approach to cholecysto-choledocholithiasis. World J Gastrointest Endosc 6:32–40

  28. 28.

    Cuschieri A, Lezoche E, Morino M et al (1999) E.A.E.S. multicenter prospective randomized trial comparing two-stage vs single-stage management of patients with gallstone disease and ductal calculi. Surg Endosc 13:952–957

  29. 29.

    Morino M, Baracchi F, Miglietta C et al (2006) Preoperative endoscopic sphincterotomy versus laparoendoscopic Rendezvous in patients with gallbladder and bile duct stones. Ann Surg 24:889–893

  30. 30.

    Rábago L, Vicente C, Soler F et al (2006) Two-stage treatment with preoperative endoscopic retrograde cholangiopancreatography (ERCP) compared with single-stage treatment with intraoperative ERCP for patients with symptomatic cholelithiasis with possible choledocholithiasis. Endoscopy 38:779–786

  31. 31.

    De-F Hong, Gao M, Br Wrs et al (2000) Intraoperative endoscopic sphincterotomy during laparoscopic cholecystectomy. World J Gastroenterol 6:448–450

  32. 32.

    Hong De-F LI, Jun-D Gao M et al (2003) One hundred and six cases analyses of laparoscopic technique combined with intraoperative cholangiogram and endoscopic sphincterotomy in sequential treatment of cholelithiasis. Chin J Gen Surg 15:648–650

  33. 33.

    Byrne M, McLoughlin M, Mitchell R et al (2009) The fate of patients who undergo “preoperative” ERCP to clear known or suspected bile duct stones. Surg Endosc 23:74–79

  34. 34.

    Yi S (2000) Recurrence of biliary symptoms after endoscopic sphincterotomy for choledocholithiasis in patients with gall bladder stones. J Gastroenterol Hepatol 15:661–664

  35. 35.

    Basso N, Pizzuto G, Surgo D et al (1999) Laparoscopic cholecystectomy and intraoperative endoscopic sphincterotomy in the treatment of cholecysto-choledocholithiasis. Gastrointest Endosc 50:532–535

  36. 36.

    Tricarico A, Cione G, Sozio M et al (2002) Endolaparoscopic rendezvous treatment: a satisfying therapeutic choice for cholecystocholedocholithiasis. Surg Endosc 16:585–588

  37. 37.

    Nakajima H, Okubo H, Masuko Y et al (1996) Intraoperative endoscopic sphincterotomy during laparoscopic cholecystectomy. Endoscopy 28:264–269

  38. 38.

    Miscusi G, Gasparrini M, Petruzziello L et al (1997) Endolaparoscopic “Rendez-vous” in the treatment of cholecysto-choledochalcalculosis. G Chir 18:655–657

  39. 39.

    Siddiqui MN, Hamid S, Khan H et al (1994) Per-operative endoscopic retrograde cholangio-pancreatography for common bile duct stones. Gastrointest Endosc 40:348–350

  40. 40.

    Cox MR, Wilson TG, Toouli J (1995) Peroperative endoscopic sphincterotomy during laparoscopic cholecystectomy for choledocholithiasis. Br J Surg 82:257–259

  41. 41.

    Meyer C, Le JV, Rohr S et al (2002) Management of common bile duct stones in a single operation combining laparoscopic cholecystectomy and peroperative endoscopic sphincterotomy. J Hepatobiliary Pancreat Surg 9:196–200

  42. 42.

    Cemachovic I, Letard JC, Begin GF et al (2000) Intraoperative endoscopic sphincterotomy is a reasonable option for complete single-stage minimally invasive biliary stones treatment: short-term experience with 57 patients. Endoscopy 32:956–962

  43. 43.

    Gurusamy K, Sahay SJ, Burroughs AK et al (2011) Systematic review and meta-analysis of intraoperative versus preoperative endoscopic sphincterotomy in patients with gallbladder and suspected common bile duct stones. Br J Surg 98:908–916

  44. 44.

    ElGeidie A (2014) Single-session minimally invasive management of common bile duct stones. World J Gastroenterol 20:144–152

  45. 45.

    Kalimi R, Cosgrove J, Marini C et al (2000) Combined intraoperative laparoscopic cholecystectomy and endoscopic retrograde cholangiopancreatography: lessons from 29 cases. Surg Endosc 14:232–234

  46. 46.

    Donatelli G, Dhumane P, Dallemagne B et al (2012) Intraoperative endoscopists-controlled guide wire cannulation technique sphincterotomy during laparoscopiccholecystectomy. J Laparoendosc Adv Surg Tech A 22:778–784

  47. 47.

    DePaula AL, Hashiba K, Bafutto M et al (1993) Laparoscopic antegrade sphincterotomy. Surg Laparosc Endosc 3:157–160

  48. 48.

    Ponsky JL, Scheeres DE, Simon I (1990) Endoscopic retrograde cholangioscopy: an adjunct to endoscopic exploration of the common bile duct. Am Surg 56:235–237

  49. 49.

    Fitzgibbons RJ Jr, Deeik RK, Martinez-Serna T (1998) Eight years’ experience with the use of a transcystic common bile duct duodenal double-lumen catheter for the treatment of choledocholithiasis. Surgery 124:699–705

  50. 50.

    Baloyiannis I, Tzovaras G (2015) Current status of laparoendoscopic rendezvous in the treatment of cholelithiasis with concomitant choledocholithiasis. World J Gastrointest Endosc 7:714–719

  51. 51.

    Morino M, Baracchi F, Miglietta C et al (2006) Preoperative endoscopic sphincterotomy versus laparoendoscopic Rendezvous in patients with gallbladder and bile duct stones. Ann Surg 244:889–893

  52. 52.

    La Greca G, Barbagallo F, Di Blasi M et al (2007) Rendez-vous technique versus endoscopic retrograde cholangiopancreatography to treat bile duct stones reduces endoscopic time and pancreatic damage. J Laparoendosc Adv Surg Tech A 17:167–171

  53. 53.

    Freeman ML, DiSario JA, Nelson DB et al (2001) Risk factors for post-ERCP pancreatitis: a prospective, multicenter study. Gastrointest Endosc 54:425–434

  54. 54.

    Barkin JS, Casal GL, Reiner DK et al (1991) A comparative study of contrast agents for endoscopic retrograde pancreatography. Am J Gastroenterol 86:1437–1441

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Correspondence to Ahmed Elgeidie.

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Dr. Ahmed Elgeidie, Dr. Ehab Atif and Dr. Gamal Elebidy have nothing to disclose.

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Elgeidie, A., Atif, E. & Elebidy, G. Intraoperative ERCP for management of cholecystocholedocholithiasis. Surg Endosc 31, 809–816 (2017).

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  • Intraoperative
  • ERCP
  • Common bile duct stones
  • Laparoscopic
  • Cholecystocholedocholithiasis
  • Cholecystectomy