Ideal timing for laparoscopic cholecystectomy post ERCP in patients with choledocholithiasis and cholelithiasis.

Nandeesh.M; Shivanand reddy K.V; Abhishek Shenoy

Volume : V, Issue : X, October - 2015

Ideal timing for laparoscopic cholecystectomy post ERCP in patients with choledocholithiasis and cholelithiasis.

Nandeesh. M, Shivanand Reddy K. V, Abhishek Shenoy

Abstract :

Background: Endoscopic retrograde cholangiopancreatography (ERCP) followed by laparoscopic cholecystectomy (LC) comprises the current treatment modality in patients with common bile duct (CBD) stones. The optimum interval between ERCP and LC is a topic of debate. Methods: A total of 60 patients underwent LC following ERCP from September 2013 to September 2015. Of these, 20 patients underwent surgery within 72 hours of ERCP (early) and 20 patients between 72 hrs and 6 weeks,following ERCP and 20 Patients underwent LC after 6 weeks. A prospective observational study of various technical difficulties encountered (operative duration, adhesions, frozen Calot’s, bile duct injuries, conversion rate and need for drain) was done and comparison was done. Results: The incidence of adhesions, frozen Calot’s, cystic duct injury, need for drain placement and the mean operative duration and postoperative stay were significantly higher in the group where surgery was done between 72 hrs and 6 weeks. The conversion rate is statistically significant in second group and the complications and conversion rate in the group where LC was done after 6 weeks was minimal. Conclusion: Early and late LC in patients post ERCP has lesser chances of encountering complications and the risk of conversion to open technique as well as the need for increased hospital stay following surgery. Late LC that is more than 6 weeks following ERCP is preferred.