A comparative study on early versus late laparoscopic cholecystectomy in a post ERCP patient with cholelithiasis with choledocholithiasis: a single institutional study in a tertiary centre in Nepal

Authors

  • Rahul Shrestha Department of Surgery, Armed Police Force Hospital, Satungal, Kathmandu, Nepal
  • Suresh Maharjan Department of Surgery, National Academy of Medical Sciences, Bir Hospital, Mahabouddha, Kathmandu, Nepal
  • Manoranjan Dwa Department of Surgery, Armed Police Force Hospital, Satungal, Kathmandu, Nepal
  • Om Prakash Patel Department of Surgery, Armed Police Force Hospital, Satungal, Kathmandu, Nepal
  • Pushkar Bhandari Department of Emergency Medicine, All Nepal Hospital, Samakhusi, Nepal

DOI:

https://doi.org/10.18203/2349-2902.isj20250804

Keywords:

Choledocholithiasis, Cholecystitis, Endoscopic retrograde cholangiopancreatography (ERCP), Gall stone, Laparoscopic cholecystectomy

Abstract

Background: An accepted surgical modality for cholelithiasis with secondary choledocholithiasis is the laparoscopic cholecystectomy (LC) following endoscopic retrograde cholangiopancreatography (ERCP). Despite recommendation for early cholecystectomy, there is no consensus about the time interval between LC and ERCP. The study aims to compare Early (<72 hours) versus Late (>6 weeks) laparoscopic cholecystectomy in post-ERCP patient with cholelithiasis with choledocholithiasis in terms of intra operative and post operative complications.

Methods: 58 patients who underwent ERCP were followed up in two groups with 29 patients each for those who had early (<72 hours) laparoscopic cholecystectomy (LC) (Group 1) and late (>6 weeks) LC (Group 2) and compared for intraoperative and post operative complications. Patients’ age, gender, abdominal ultrasonography findings, ERCP findings, time interval between ERCP and LC, conversion rate, length of hospital stay, operation time, intraoperative complication and postoperative complication rates were collected.

Results: The mean±SD age of the study participants in this study was 45.5±15.8 years. No patients underwent conversion to open cholecystectomy. Operative time were similar in both groups (p=0.941). There was no statistically significant difference in difficult in Calot’s dissection and time to achieve critical view of safety. No biliary tract injury was reported while requirement for blood transfusion (p=0.490) and drain placement (p=0.610) were similar in both groups.

Conclusions: The intra operative and post operative outcome with early (<72 hours) and late (>6 weeks) laparoscopic cholecystitis post ERCP in patients with cholelithiasis and choledocholithiasis is similar.

 

Metrics

Metrics Loading ...

References

Goel A, Bansal R, Kothari S. Comparative analysis of early versus late laparoscopic cholecystectomy following endoscopic retrograde cholangiopancreatography in cases of cholelithiasis with choledocholithiasis. Eur J of Hepato-Gastroenterol. 2021;11(1):11–3. DOI: https://doi.org/10.5005/jp-journals-10018-1338

Williams EJ, Green J, Beckingham I, Parks R, Martin D, Lombard M. Guidelines on the management of common bile duct stones (CBDS). Gut. 2008;57(7):1004–21. DOI: https://doi.org/10.1136/gut.2007.121657

Cianci P, Restini E. Management of cholelithiasis with choledocholithiasis: Endoscopic and surgical approaches. World J of Gastroenterol. 2021;27(28):4536–54. DOI: https://doi.org/10.3748/wjg.v27.i28.4536

Kostro J, Marek I, Pȩksa R, Łaski D, Hellmann AR, Kobiela J, et al. Cholecystectomy after endoscopic retrograde cholangiopancreatography - Effect of time on treatment outcomes. Przeglad Gastroenterol. 2018;13(3):251–7. DOI: https://doi.org/10.5114/pg.2018.78292

Friis C, Rothman JP, Burcharth J, Rosenberg J. Optimal Timing for Laparoscopic Cholecystectomy After Endoscopic Retrograde Cholangiopancreatography: A Systematic Review. Scandinavian J of Surg. 2018;107(2):99–106.

Oh DJ, Nam JH, Jang DK, Lee JK. Complications of common bile duct stones: A risk factors analysis. Hepatobil & Panc Dis Int. 2021;20(4):361–5. DOI: https://doi.org/10.1016/j.hbpd.2021.04.008

Nassar AHM, Ng HJ, Katbeh T, Cannings E. Conventional surgical management of bile duct stones: a service model and outcomes of 1318 laparoscopic explorations. Ann Surg. 2022;276(5):493. DOI: https://doi.org/10.1097/SLA.0000000000004680

Overby DW, Apelgren KN, Richardson W, Fanelli R. SAGES guidelines for the clinical application of laparoscopic biliary tract surgery. Surg Endosc. 2010;24(10):2368–86. DOI: https://doi.org/10.1007/s00464-010-1268-7

Manes G, Paspatis G, Aabakken L, Anderloni A, Arvanitakis M, Ah-Soune P, et al. Endoscopic management of common bile duct stones: European society of gastrointestinal endoscopy (ESGE) guideline. Endoscop. 2019;51(05):472–91. DOI: https://doi.org/10.1055/a-0862-0346

Ammori BJ, Larvin M, McMahon MJ. Elective laparoscopic cholecystectomy: Preoperative prediction of duration of surgery. Surg Endosc. 2001;15(3):297–300. DOI: https://doi.org/10.1007/s004640000247

Friis C, Rothman JP, Burcharth J, Rosenberg J. Optimal timing for laparoscopic cholecystectomy after endoscopic retrograde cholangiopancreatography: a systematic review. Scandinavian J Surg. 2018;107(2):99–106. DOI: https://doi.org/10.1177/1457496917748224

Abdalkoddus M, Franklyn J, Ibrahim R, Yao L, Zainudin N, Aroori S. Delayed cholecystectomy following endoscopic retrograde cholangio-pancreatography is not associated with worse surgical outcomes. Surgical Endos. 2022;36(5):2987–93. DOI: https://doi.org/10.1007/s00464-021-08593-w

Boerma D, Rauws EA, Keulemans YC, Janssen IM, Bolwerk CJ, Timmer R, et al. Wait-and-see policy or laparoscopic cholecystectomy after endoscopic sphincterotomy for bile-duct stones: a randomised trial. The Lancet. 2002;360(9335):761–5. DOI: https://doi.org/10.1016/S0140-6736(02)09896-3

Lau JYW, Leow C, Fung TMK, Suen B, Yu L, Lai PBS, et al. Cholecystectomy or gallbladder in situ after endoscopic sphincterotomy and bile duct stone removal in chinese patients. Gastroenterol. 2006;130(1):96–103. DOI: https://doi.org/10.1053/j.gastro.2005.10.015

McAlister V, Davenport E, Renouf E. Cholecystectomy deferral in patients with endoscopic sphincterotomy. Cochrane Database Syst Rev. 2007;4:6233. DOI: https://doi.org/10.1002/14651858.CD006233

Bostanci EB, Ercan M, Ozer I, Teke Z, Parlak E, Akoglu M. Timing of elective laparoscopic cholecystectomy after endoscopic retrograde cholangiopancreaticography with sphincterotomy: a prospective observational study of 308 patients. Langenbecks Arch Surg. 2010;395(6):661–6. DOI: https://doi.org/10.1007/s00423-010-0653-y

Downloads

Published

2025-03-26

How to Cite

Shrestha, R., Maharjan, S., Dwa, M., Patel, O. P., & Bhandari, P. (2025). A comparative study on early versus late laparoscopic cholecystectomy in a post ERCP patient with cholelithiasis with choledocholithiasis: a single institutional study in a tertiary centre in Nepal. International Surgery Journal, 12(4), 494–499. https://doi.org/10.18203/2349-2902.isj20250804

Issue

Section

Original Research Articles