Laparoscopic Cholecystectomy After Endoscopic Sphincterotomy

Endoscopic sphincterotomy (EST) followed by laparoscopic cholecystectomy (LC) has been increasingly used for gallstones or common duct stones (EST+LC). Between May, 1992 and April, 1995, we performed LC in 308 patients, of whom 31 underwent EST+LC, EST+LC was compared with conventional laparotomy-cholecystectomy, T tube drainage (laparotomy T tube), and LC without preceding EST (conventional LC). LC could be achieved in 29 of the 31 patients who underwent EST+LC, but laparotomy was subsequently required in the other 2 due to Mirizzi syndrome and embedded gallbladder, respectively. EST was not the cause of laparotomy. Of the 29 patients in whom EST+LC could be achieved, 3 underwent ERCP on the suspicion of residual stones. Residual stones were observed in 2 patients but could be removed under endoscopic guidance. EST+LC was superior to laparotomy T tube in the hospitalization period, cost, and the degree of invasion. The preceding EST did not make LC difficult in any patient, or did not increase complications EST did not impair the low invasiveness of LC. These results suggest the usefulness of EST+LC for gallstones and common bile duct stones