Laparoscopic-Endoscopic Rendezvous (LERV) In Patients Undergoing Laparoscopic Cholecystectomy For Stones In The Gallbladder And Bile Duct

Aims The management of gallbladder stones concomitant with bile duct (BD) stones is controversial. The usual approach is a two-stage procedure, with endoscopic sphincterotomy and stone removal from the BD followed by laparoscopic cholecystectomy. The laparoscopic-endoscopic rendez-vous combines the two techniques in a single-stage operation.

Retrospective review of patients who underwent LERV was performed. Patient characteristics, pre/postoperative laboratory values, complications and readmissions were reviewed. LERV was conducted during laparoscopic cholecystectomy for evidence of choledocholithiasis with or without preoperative biliary pancreatitis or cholangitis. Following confirmatory intraoperative cholangiogram, a flexible tip guidewire was inserted antegrade into the cystic ductotomy, through the BD across the ampulla in the duodenum and retrieved with a duodenoscope. Standard ERCP maneuvers to clear the bile duct are then performed.

Methods Retrospective review of patients who underwent LERV was performed. Patient characteristics, pre/postoperative laboratory values, complications and readmissions were reviewed. LERV was conducted during laparoscopic cholecystectomy for evidence of choledocholithiasis with or without preoperative biliary pancreatitis or cholangitis. Following confirmatory intraoperative cholangiogram, a flexible tip guidewire was inserted antegrade into the cystic ductotomy, through the BD across the ampulla in the duodenum and retrieved with a duodenoscope. Standard ERCP maneuvers to clear the bile duct are then performed.

Results From March 2018 to October 2020 sixty one patients (31 female/30 male, mean age 70,1) underwent intraoperative ERCP using LERV technique. Only one patient underwent LERV for acute biliary pancreatitis, in two cases for acute cholecystitis with cholangitis, the other cases were treated in election setting (90 %). Only in five cases (8 %) the LERV was not successfully completed and traditional intraoperative ERCP was performed. Of all cases successfully treated with LERV technique two were gastrectomy with Roux-en-Y gastrojejunostomy, only in three cases (4,9 %) biliary clearance was not completed so temporarily a pigtail prosthesis was positioned and in 13 cases (about 21 %) a peripapillary duodenal diverticulum was found. There were no cannulations or injections of the pancreatic duct. There were no intraoperative complications associated with the ERCP and no patients developed post ERCP pancreatitis. Average length of the hospital stay was 9 days.

Conclusions LERV procedure is at par with two-stage technique in terms of CBD clearance, may lead to longer operating times but may reduce the length of the hospital stay, the incidence of post-operative pancreatitis and overall morbidity.

Citation Broglia F, Leoni P, Lumachi V et al. eP323 LAPAROSCOPIC-ENDOSCOPIC RENDEZVOUS (LERV) IN PATIENTS UNDERGOING LAPAROSCOPIC CHOLECYSTECTOMY FOR STONES IN THE GALLBLADDER AND BILE DUCT. Endoscopy 2021; 53: S203.

Publication History

Article published online:
19 March 2021