Routine vs ``on demand'' postoperative ERCP for small bile duct calculi detected at intraoperative cholangiography

Abstract

A "wait and see" policy of observation alone for patients with small bile duct calculi detected at IOC during LC appears to be safe, and it is more cost-effective than routine postoperative ERCP. ERCP should be reserved for post-LC patients who become symptomatic.

Scoring system to predict asymptomatic choledocholithiasis before laparoscopic cholecystectomy

“…Furthermore, some considerations lead us to believe that the data obtained are not all that different from the definitive ones. Since most patients with retained bile duct stones present within a few weeks or months [4] and often no later than 2 years following LC [34], the follow-up time in the current study is probably adequate. In a previous evaluation, we showed that the probability of misidentifying stones in the duct is reasonably low using this system.…”

Routine versus selective intraoperative cholangiography during laparoscopic cholecystectomy

“…Management of the unexpected ductal stones found by IOC during LC also presents a dilemma. Two approaches can be undertaken: routine postoperative ERCP for all patients in whom IOC has detected ductal stones or observing of these patients and reserving ERCP for those who develop symptoms during follow-up [5,15]. Although ERCP is quite efficient in the management of ductal stones, it has a morbidity rate of 7-11% and a mortality of <1% [16,17], especially if accompanied by ES [18].…”

Cholecystocholedocholithiasis: a case–control study comparing the short- and long-term outcomes for a “laparoscopy-first” attitude with the outcome for sequential treatment (systematic endoscopic sphincterotomy followed by laparoscopic cholecystectomy)

“…In fact, all the proposed protocols (ERCP before [8,11], after [12,13], or even during [3,11] the laparoscopic cholecystectomy) have important drawbacks. Performing ERCP before surgery raises questions regarding patient selection because systematic preoperative ERCP before LC means an intolerably great number of useless procedures.…”