الفهرس 
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Abstract
The present study was carried out on 20 patients with symptomatic cholelithiasis admitted to Menoufiya University Hospitals (general surgery department) with cholelithiass and choledocholithiasis.
The aim of this work was to evaluate the treatment of gall stones and common bile duct stones (CBDS) in a one-stage operation by intraoperative endoscopic retrograde cholangiopancreatography followed by laparoscopic cholecystectomy (LC) (IO-ERCP &LC).
The patients were 15 females and 5 males and the age of the patients ranged from 20-81 years with a mean of 51.05±18.24.
There were 18 cases were suffering from some comorbidities, These comorbidities were DM in 4 (20%) patients, HTN in 5 (25%) patients, HCV in 3 (15%) patients, Hyperthyroidism in 1(5%) patient and recent delivery in 5 (25%) patients.
By ultrasound, there were 16 cases (80%) with thickened gall bladder wall and 4 cases (20%) with average gall bladder wall thickness. By ultrasound, the most common content of the gall bladder was small stones seen in 16 (80 %) cases then biliary mud in 4(20%) cases The IHBR was seen dilated in 7(35%) cases and not dilated in 13 (65%) cases by the ultrasound. With the help of ultrasound, The CBD was seen dilated in 14 (70%) cases and not dilated in 6 (30%) cases
In this study, 20 patients were listed to do ERCP & lapcholecystectomy in a single session. Same session succeeded in 17 (75%) cases and 3 (25%) case failed (shifted to other technique). There was no mortality.
By ERCP, multiple small stones were extracted in 10 (50%) cases, biliary mud in 2 (10%) cases, a big stone in 2 (10%) cases and no stones was extracted (passed stones) in 5 (25%) cases. In this study, and only one case failed ERCP due to failed cannulation
The following points were concluded from this study:
Clinical and sonographic data may help predict a difficult laparoscopic cholecystectomy which is very useful to the patient and surgeon.
Patients with gall stone disease should be advised for early elective laparoscopic cholecystectomy to avoid gall stone complications and CBD stones.
The early Endoscopic Retrograde Cholangio Pancreatography and Laparoscopic Cholecystectomy were done the less complication as pancreatitis was happened.
The experience of the surgeon to do Endoscopic Retrograde Cholangio Pancreatography and Laparoscopic Cholecystectomy is the most important factors to achieve a low complication rate.
The failure to do Endoscopic Retrograde Cholangio Pancreatography is not a problem, but the problem is to do with complications and the better to convert the patient to other technique.