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Modified technique of laparoendoscopic rendezvous ERCP during laparoscopic cholecystectomy for concomitant gallstone and common bile ductal stone.

Laparoendoscopic rendezvous ERCP and laparoscopic cholecystectomy (LC+ERCP/LERV) is considered an optimal approach for concomitant gallstone and common bile duct stone, but this procedure could be failed due to some technical challenges. We describe a modified technique which was adopted in 32 consecutive cases and yielded good results. A Dormia basket is inserted through cystic duct to enter duodenum and grasp the guide wire which is introduced with sphincterotome through endoscope. After pulling the basket catheter and guide wire into bile duct, the selective bile duct cannulation could be achieved by advancing sphinterotome over guide wire. An atraumatic clamp is also used to temporarily occlude proximal jejunum preventing diffuse bowel distention by air insufflation. The procedure was successfully performed in 31 cases(96.8%) , the mean operative time and endoscopic time were 82.6±19.6 min and 26.5±5.99min, respectively. This modified technique is safe, feasible and associated with short operative time.