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10.5005/jp-journals-10033-1220
Laparoscopic Cholecystectomy after Endoscopic Retrograde Cholangiopancreatography: The Optimal Timing for Operation
OriginaL articLe

Laparoscopic Cholecystectomy after Endoscopic

Retrograde Cholangiopancreatography:
The Optimal Timing for Operation

2
1 Samir A Ammar, Mohamad Abdel Bar, Mohy El Shafy
3
ABSTRACT disease. There is no consensus on the correct strategy for
Background: In patients with choledochocystolithiasis (CCL), the care of simultaneous gallbladder and common bile duct
early laparoscopic cholecystectomy (LC), within 72 hours, is (CBD) stones. Many therapeutic options are available,
recommended after endoscopic stone extraction. The objec- including laparoscopic, endoscopic, percutaneous and
tive of this study is to investigate LC for CCL within 24 hours of
endoscopic retrograde cholangiopancreatography (ERCP) to open traditional techniques, either through a combination
determine its feasibility and safety. of these treatments or by conducting them in a stepwise
Materials and methods: Group I, those patients who had LC sequence. Endoscopic retrograde cholangiopancreatography
within 24 hours after ERCP was compared with group II, those (ERCP) remains the preferred approach at most centers for
who had LC after 24 hours, but within 72 hours. Primary outcome managing patients with suspected CBD stones. A CBD
1,2
was the conversion rate from LC to open cholecystectomy.
Secondary outcomes were duration of LC, postoperative clearance can be carried out by ERCP with endoscopic sphinc-
morbidity and hospital stay. terotomy (ES) before laparoscopic cholecystectomy (LC) in
many cases, and it is the most common strategy used in the
Results: Of 60 consecutive patients, 31 were in group I and
1
29 were in group II. There were no differences in groups I vs II majority of hospitals worldwide.
in demographics, laboratory or ultrasonographic findings. The The safety of early LC after ES for choledochocystolithi-
hospital stay in group I was significantly shorter than that of asis (CCL) has already been investigated in observational
group II (2.5 ± 1.5 vs 4 ± 2 days respectively). There was no
statistically significant difference in operative time, conversion and randomized studies; early LC, within 72 hours, has a
3-8
to open cholecystectomy or postoperative morbidity between better outcome than delayed. Early elective LC should be
both groups. carried out for all surgically fit patients, regardless of age,
Conclusion: LC for CCL within 24 hours after ERCP is feasible since it may prevent biliary complaints related to GB stones,
and safe with short hospital stay. further CBD procedures or emergency surgery, which is a
9
Keywords: Laparoscopic cholecystectomy, Gallstones, Common more difficult procedure with poorer results. However, no
bile duct stones, Timing of operation. clinical trials address LC within 24 hours after ERCP. The
How to cite this article: Ammar SA, Bar MA, El Shafy M. Lapa ro - purpose of this study is to evaluate feasibility and safety of
s copic Cholecystectomy after Endoscopic Retrograde Cholangio-
pancreatography: The Optimal Timing for Operation. World J Lap LC within 24 hours after ES for CCL.
Surg 2014;7(2):69-73.
Source of support: Nil MATERIALS And METhOdS
Conflict of interest: None This prospective randomized study was carried out in the
period from January 2011 to January 2014 at Department
InTROduCTIOn of Surgery, Assiut university Hospital, Egypt. All patients
of 18 years and older who underwent successful ERCP and
Symptomatic cholecystolithiasis is one of the most ES and stone extraction for choledocholithiasis and who
common gastrointestinal surgical entities, and a considerable had radiologically proven residual gallbladder stones were
amount of patients present with complications of gallstone
eligible for inclusion. Patients were divided into two groups:
Group I, those patients who had LC within 24 hours after ES

1 Assistant Professor, Senior Resident, Professor and group II, those who had LC after 24 hours, but within
2
3
72 hours of ERCP.
1-3 Department of Surgery, Assiut University Hospital, Assiut
Egypt Our exclusion criteria were, contraindication or failure of
ERCP, previous abdominal operations, associated comor-
Corresponding Author: Samir A Ammar, Assistant
Professor, Department of Surgery, El Gamaa Street, Assiut bidities, pregnancy, or evidence of inflammation: cholangitis
University Hospitals, Assiut, Egypt, Phone: 02-0882180562 [abdominal pain, fever, elevated bilirubin, ele vated leuko-
e-mail: samirahmed70@hotmail.com
cyte count/C-reactive protein (CRP) and pus drainage after
World Journal of Laparoscopic Surgery, May-August 2014;7(2):69-73 69