Laparoscopic Cholecystectomy: Who Does What, When and to Whom?

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

“…In the laparoscopic era, approaches to the management of chole− docholithiasis range from laparoscopic treatment alone [5,9], with transcystic common bile duct exploration or laparoscopic choledochotomy [5] (with intraoperative or postoperative ERCP as salvage treatment for failures) to pre− or postoperative, two− stage, combined ERCP/laparoscopic management [4]. The use of these new treatment options depends more on the technical skills and experience of the endoscopic or surgical teams than on a clearly established and accepted consensus [10].…”

Drainage of Gallbladder Fossa Fluid Collections with Endoprosthesis Placement Under Endoscopic Ultrasound Guidance: A Preliminary Report of Two Cases

“…When they persist for a longer period and are associated with clinical symptoms or signs, complica− tions such as bile leak, bleeding, or abscess formation must be excluded [3]. Such collections are diagnosed and treated by nee− dle aspiration or drainage guided by transcutaneous ultrasound or computed tomography (CT) [4], by endoscopic retrograde cho− langiopancreatography (ERCP) with sphincterotomy or place− ment of an endoprosthesis [5,6], or with surgically placed drain− age catheters [7,8].…”

“…When they persist for a longer period and are associated with clinical symptoms or signs, complica− tions such as bile leak, bleeding, or abscess formation must be excluded [3]. Such collections are diagnosed and treated by nee− dle aspiration or drainage guided by transcutaneous ultrasound or computed tomography (CT) [4], by endoscopic retrograde cho− langiopancreatography (ERCP) with sphincterotomy or place− ment of an endoprosthesis [5,6], or with surgically placed drain− age catheters [7,8].Developments in endoscopic ultrasound (EUS) permit the char− acterization of intra− and extramural lesions, tissue aspiration for diagnosis [9 ± 12], and the drainage of extramural fluid collec− tions, especially those associatied with pancreatic disease [13 ± 15]. We report two cases of persistent fluid collections in the gallbladder fossa which failed to resolve after ERCP−based inter− ventions.…”

Intraoperative Endoscopic Sphincterotomy is a Reasonable Option for Complete Single-Stage Minimally Invasive Biliary Stones Treatment: Short-Term Experience with 57 Patients

“…has not yet gained wide recognition as an effective method for a one-session treatment of both cholecystolithiasis and choledocholithiasis. This is probably due to early negative reports [2] which discouraged its use [3]. However, IOES, performed before gallbladder resection, was later described by a few authors mainly in association with laparoscopic assistance such as placement of a transcystic catheter to be used as a guide for papillotomy with a needle knife in 28 patients [4], with a transcystic guide wire inserted for a rendezvous technique with the endoscope in two patients [5], or with a Dormia basket driven through the cystic duct across the papilla in order to catch the sphincterotome and pull it upwards inside the CBD [6].…”