Intraoperative endoscopic papillotomy and stone removal.

Endoscopic papillotomy was attempted during cholecystectomy in 33 patients who suffered from both gallbladder and bile duct stones simultaneously (32 conventional, 1 laparoscopic cholecystectomy). Twenty-six of these patients suffered from acute obstruction of the biliary tree which required urgent operation. In addition, 10 of these patients suffered from acute biliary pancreatitis. Because of the unusual intraoperative conditions, cannulation of the papilla was modified ("orthograde papillotomy"); the instruments used were the same as for conventional endoscopic papillotomy. In 28 out of these 33 patients (85%) intraoperative endoscopic papillotomy (IOEP) and duct stone retrieval proved successful, while in the remaining 5 it was inapplicable. Intraoperative endoscopic papillotomy caused one complication which was discovered during the operation and which immediately and easily was corrected. The time for this operative technique was shorter than for the conventional bile duct operation. Over a follow-up of on average of one year, no residual stones or newly formed concrements were found or other delayed complications induced by papillotomy arose. In this series, IOEP proved to be safe and practical, which in comparison to conventional duct exploration reduced inconvenience to the patient. Compared with laparoscopic bile duct operations, IOEP may be preferable because of its modest requirement of time and apparatus as well as its applicability in cases where the common bile duct is difficult to handle.