LAP CHOLE AND ERCP WITH STONE EXTRACTION - AS A COMBO SINGLE STAGED APPROACH

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"LC + ERCP - AS A COMBO APPROACH"-FOR MANAGEMENT OF CHOLECYSTO-CHOLEDOCHOLITHIASES. SREEJOY PATNAIK MS, SHANTI MEMORIAL HOSPITAL , PVT LTD . CUTTACK,ORISSA
INTRODUCTION: In the management of Cholecysto-choledocholithiases, Laparoscopic Cholecystectomy and ERCP is today the treatment of choice.Other options exists including Pre & Post operative ERCP, Lap. CBD exploration transcystic approach, Lap. Choledochotomy, open CBD exploration. The risk of Pancreatitis is higher in pre & postop extraction of stones by ERCP & in 10% of cases pre-op. ERCP may be normal. The alternative technique of laparoscopic cholecystectomy first followed by ERCP and stone extraction is emerging as a single step combo approach.
MATERIALS AND METHODS: This is retrospective study done on 75 cases, who underwent laparoscopic cholecystectomy and ERCP and stone extraction and biliary stenting as a single step procedure from 2008 to 2013. Patient criteria included 1. Gallstones with CBD stones < 10mm, confirmed by pre-operative USG. 2.Raised LFT specifically Serum Birilubin and Serum Alkaline Phosphatase.3. Serum amylase & lipase was done to exclude pancreatitis. Mild to moderate Pancreatitis patients were subjected to pre-op conservative treatment followed by the definitive procedure. 4. Upper GI Endoscopy was done in all cases to exclude any gastric outlet obstruction & ulcer disease.Under GA Classical Laparoscopic Cholecystectomy was done first , followed by Diagnostic ERCP and cholangiogram in a prone position to confirm CBD stones.This was followed by wide Endoscopic sphincterotomy, stone extraction by basket or balloon and retrograde biliary stenting.
RESULTS: This Combo Approach was found to be time saving, cost effective, with decreased risk of anaesthesia.overall patient satisfaction.
CONCLUSIONS: LC + ERCP as a combo approach with confirmed GB with CBD sones is an alternative technique in a resource limited semi urban centre where the availaibility of MRCP is lacking. This technique offers cost reduction , decreased LOS , and over all patient satisfaction.

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