Treatment of common bile duct stones--is the role of ERCP changed in era of minimally invasive surgery?

UNLABELLED In 10-15% of the patients that underwent cholecystectomy, common bile duct stones were found either during the preoperative, intraoperative or postoperative evaluation. Their treatment traditionally was based on open approach and extraction of calculi, with development of endoscopic procedures we have ERCP with endoscopic sphincterotomy, but due to rapid development of laparoscopic procedures now-days we have other therapeutic options such as laparoscopic transcystic extraction and laparoscopic choledohotomy. METHODS During the period between 2007-2009 we treated 168 patients with common bile duct stones. Age range was 21-78 years, 105 female and 63 male patients. We have performed 47 open explorations, 9 laparoscopic transcystic exploration, as well as 112 ERCP and ES. We monitored the rate of success (%), intra- and postoperative complications. RESULTS The success rate of the cases of open exploration was 95%, in 2 cases postoperative cholangiogram showed concrement residues that were successfully treated later on with ERCP+ES. Out of 9 transcystic LCBDE we have performed, in 4 cases extraction was successful, 3 patients underwent conversion into open exploration, and 2 patients were successfully treated with postoperative ERCP. A total of 69 patients were treated with ERCP and ES with the 82% success rate of stone extraction. CONCLUSION Even though laparoscopic and endoscopic procedures have revolutionized treatment of common bile duct stones, the role of ERCP is not changed. Treatment in general hospital settings largely depends on availability of endoscopic and laparoscopic equipment and expertise, and must be individualized according to methods that are available. In our settings we have found that best summary of these demands are achieved by ERCP and laparoscopic approach.