Endoscopic retrograde cholangio pancreatography (ERCP) – a novel risk factor for conversion of laparoscopic cholecystectomy

Abstract

Introduction: Laparoscopic cholecystectomy is the standard care for symptomatic gall stone disease. Although open cholecystectomy has a longer convalescence, it is considered a safe approach when difficulties are encountered during laparoscopic surgery. Though Studies have shown many risk factors for conversion the effect of preoperative ERCP is scarce worldwide. Methods: Two hundred and two consecutive laparoscopic(LC) and laparoscopy converted to open(LCOC) cholecystectomies performed on patients attending a tertiary referral centre from 2014 to 2016 were analysed using SPSS version 20.0 Results: One hundred and thirty three LC and 69 LCOC were done with a conversion rate of 34.1%. Majority were females(76%). Mean age was 46.35 years(range 16e80). Demographic data and surgical factors are comparable in both groups. All patients with choledocholithiasis underwent ERCP prior to cholecystectomy. Fifty two percent and 6% had ERCP pre operatively in LCOC and LC groups respectively(OR -13.9, 95% CI 5.8-32.9). Eighty one percent of the patients who underwent ERCP had a conversion(p < 0.001). ERCP with common bile duct stenting(11%) had no significant correlation with the conversion. There is no significant association between number of ERCP and conversion(Median -2, Range 1-5).Mean duration after ERCP to surgery was 20.3 weeks(range-2-48 weeks) in LCOC group. No bile duct injuries were reported in both groups. Conclusion: High conversion rate of our case series could be due to the complexity of the referrals. ERCP is a significant risk factor for conversion according to our data. Post ERCP patients should be informed about the higher risk of conversion. Inflammatory myofibroblastic tumors are rare benign tumors that can mimic malignancy of unknown aetiology. It has spectrum of myofibroblastic proliferation along with varying amount of inflammatory infiltrate. Recently, the concept of this lesion being reactive has been challenged based on the clinical demonstration of recurrences and metastasis and cytogenetic evidence of acquired clonal chromosomal abnormalities. We hereby report a case series of three patients with inflammatory myofibroblastic tumour involving gallbladder, liver.Inflammatory myofibroblastic tumor (IMT) occurs more frequently in childhood and the most common involvement is seen in the lungs. Primary inflammatory myofibroblastic tumors of the gallbladder are rather infrequent. The present knowledge is based on case reports. Initiating factors such as reactive, infections, autoimmune and neoplastic processes, has been proposed but the etiology of most remains unknown. The most frequently involved organ in the abdomen is the liver, while primary gallbladder involvement is quite rare. Present knowledge about this entity is based on case reports in the literature (9). The clinical picture in cases with IMT depends on the organ of involvement and site of the organ; abdominal pain, jaundice and ascites might be the presenting symptoms, according to the localisation in the liver involvement.In our cases symp...