Optimal timing of laparoscopic cholecystectomy after endoscopic retrograde cholangiopancreatography

Abstract

INTRODUCTIONSymptomatic cholelithiasis is a common gastrointestinal surgical entity having the complication of accumulation of gall stones. Although, therapeutic options are laparoscopic, endoscopic, percutaneous surgery and open traditional technique either through a combination of any of cited treatments or by conducting those in a step wise sequence to manage gallstones and common bile duct (CBD) stones, there is no clear consensus on the correct strategy.Obviously, endoscopic retrograde cholangiopancreatography (ERCP) remains the preferred approach for assessing CBD stones in patients. Often, a CBD clearance is carried out by ERCP with the endoscopic sphincterotomy (ES), before laparoscopic cholecystectomy (LC) as the preferred strategy. ABSTRACTBackground: Nowadays in patients with cholelithiasis with choledocholithiasis, the ideal treatment is endoscopic retrograde cholangiopancreatographic (ERCP) removal of duct stone and laparoscopic cholecystectomy. But when to do and whether we can do it simultaneously or one after another and what interval should be there, that is always controversial. The purpose was an optimal gap for cholecystectomy after ERCP. Methods: We have done a comparison study in 60 patients within a duration of 2 year who had already done ERCP. Group 1, those patients who had laparoscopic cholecystectomy within 72 hours compared with group 2 who had laparoscopic cholecystectomy after an interval of 6 week. Primary outcome was the conversion rate from lap to open cholecystectomy. Secondary outcome was duration of operation, intra-operative difficulties, postoperative morbidity and hospital stay. Results: Of 60 consecutive patients 30 were in group I and 30 were in group II. There is no difference in demographics, laboratory or ultrasonographic findings. The hospital stays in group I is significantly shorter than group II and conversion rate; operative time is higher in group II. No statistically significant difference in postoperative morbidity between both groups. Conclusions: Early laparoscopic cholecystectomy within 72 hr is better than interval (6 week) cholecystectomy after ERCP with shorter hospital stay and less intraoperative difficulties.

Best Time for Laparoscopic Cholecystectomy Following Endoscopic Sphincterotomy Post Endoscopic Retrograde Cholangiopancreatography: A Prospective Observational Study

“…In the current study, the mean hospital stay duration for group I patients was notably shorter than the mean hospital stay duration for group II patients (p<0.001). This finding mimics many kinds of literature such as Sahoo et al [23] studies in India and the El-Labban study in Egypt [24] which all reported that patients with earlier time intervals between ERCP and LC had shorter hospital stay duration than patients with later interval.…”

Comparative Analysis of Early versus Late Laparoscopic Cholecystectomy Following Endoscopic Retrograde Cholangiopancreaticography in Cases of Cholelithiasis with Choledocholithiasis

“…In this study, there was no significant difference seen among demographic findings that correlate with the previous studies. 9 , 10 However, significant preoperative ultrasound finding was increased wall thickness in group II. 10 It was clearly observed that and seen consistent with our studies that the duration of surgery and hospital stay was significantly more in patients undergoing LC after an interval of 8 weeks.…”

“… 9 , 10 However, significant preoperative ultrasound finding was increased wall thickness in group II. 10 It was clearly observed that and seen consistent with our studies that the duration of surgery and hospital stay was significantly more in patients undergoing LC after an interval of 8 weeks. 9 – 11 Operative difficulty and grade of adhesions were significantly higher in cases undergoing surgery after a delayed period, and this observation is clearly supported by many studies.…”

“…8 – 11 Many studies have shown a significant difference in conversion to open cholecystectomy, but in our study, however, cases of conversion were more in delayed group but statistically insignificant. 9 , 10 …”

“… 4 – 6 Many recent studies have shown that an interval of 6 to 8 weeks post-ERCP has shown increased operative difficulty as well as increased rate of conversion to open cholecystectomy. 7 – 10 It is important to reduce morbidity and complications for the patients. The aim of this study was to compare and analyze the various parameters like operative difficulty, duration of surgery, hospital stay, complications, and conversion to open cholecystectomy among the patients undergoing LC immediately following the CBD stone extraction by ERCP with those undergoing LC after an interval of 8 weeks.…”