Simultaneous common bile duct clearance and laparoscopic cholecystectomy: experience of a one-stage approach

Abstract

Introduction The timing and optimal method for common bile duct (CBD) clearance and laparoscopic cholecystectomy remains controversial. Several different approaches are available in clinical practice. The current study presents the experience of two European hospitals of simultaneous laparoscopic cholecystectomy (LC) and intra-operative endoscopic retrograde cholangiopacreatography (IO-ERCP) done by surgeons. Methods Retrospective analysis of all consecutive patients subjected to LC + IO-ERCP during their index admission between 4/2014 and 9/2016. Data accrued included patient demographics, laboratory markers, operation time (min) reported as mean (± SD) and hospital length of stay (LOS) reported as median (lower quartile, upper quartile). Results During the 29-month study, a total of 201 consecutive LC + IO-ERCPs were performed. The mean age of patients was 55 ± 19 years and 67% were female. The mean intervention time was 105 ± 44 min. The total LOS was 4 (3, 7) days and the post-operative LOS was 2 (1, 3) days. A total of 6 (3%) patients experienced post-interventional pancreatitis and two (1%) patients suffered a Strasberg type A bile leak. All patients were successfully discharged. Conclusion Simultaneous LC + IO-ERCP is associated with few complications. Further studies investigating cost-benefit and patient satisfaction are warranted.

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

“…In our study, no remarkable differences were noted between CBD stone patients of group I and group II in relation to difficult Calot triangle dissection and the need for drain insertion. These results mimic the results of Mohseni et al study [22]. 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).…”

Patterns of prevalence and contemporary clinical management strategies in complicated acute biliary calculous disease: an ESTES ‘snapshot audit’ of practice

“…Endoscopic duct clearance is the mainstay of treatment, most commonly followed by definitive management of the stone reservoir by cholecystectomy. Although most of patients (89%) followed this sequence, 11% had one-stage approach with simultaneous laparoscopic cholecystectomy and on-table ERCP; there are favorable data emerging which should prompt consideration of this approach where technically and logistically feasible [28][29][30].…”

A meta-analysis of the use of intraoperative cholangiography; time to revisit our approach to cholecystectomy?

“…In their meta-analysis, Pan and colleagues found that LCBDC during laparoscopic cholecystectomy (LC) has superior outcomes to a preoperative ERCP sphincterotomy followed by LC and should be considered as the optimal treatment choice for CBD stones [ 67 ]. Mohseni et al, in a recent retrospective study of more than 200 patients undergoing simultaneous intraoperative ERCP with LC, found that this approach was associated with few complications [ 68 ].…”