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Samir A Ammar et al
ES], pancreatitis (upper abdominal pain, elevated leukocyte STATISTICAL AnALySIS
count/CRP, elevated amylase at least 3 times normal, and Statistical analyses were performed using the Statis tical
elevated lipase levels), and cholecystitis (pain in the right Package for Social Sciences, version 16.0 (SPSS Inc,
upper quadrant, fever and leukocytosis, in the absence of Chicago, IL, uSA). Data are expressed as mean ± standard
hyperbilirubinemia). deviation (SD) for continuous variables and percentages
All patients were subjected to complete evaluation for categorical variables. Student t-test was used to analyze
through a detailed history, complete physical examination, continuous variables, whereas chi-square test was used to
laboratory investigations, and imaging study (uS and/or analyze categorical variables. p-value is considered statisti-
MRCP). Randomization was done using computer- cally significant when less than 0.05.
gene rated random number sequences. ERCP was performed
for all patients under general anesthesia. If CBD stones RESuLTS
were found on endoscopic cholangiography, ES was per-
formed and the stones were extracted using either Dormia During the period of the study, out of 65 patients recruited,
basket or balloon catheter. Mechanical lithotripsy was done 60 patients were included in the final analysis. Five patients
in cases of large stones. Occlusion cholangiography was were complicated by mild post ERCP pancreatitis, 3 in group
done at the end of every ERCP to ensure that no missed I and 2 in group II, and excluded from the final analysis.
stones. Patients with acute pancreatitis were treated successfully
Laparoscopic cholecystectomy was done in both groups with conservative treatment. No other post ERCP complica-
by the same surgical team using the standard four-port tions were reported.
technique. In case of difficulty or complication, conversion Laparoscopic cholecystectomy was performed in 31
to open cholecystectomy was done by a subcostal incision. patients in group I and in 29 patients in group II. The age
The decision for conversion could only be taken by the most ranged from 25 to 65 years (mean 46 ± 12.8). Both groups
experienced surgeon in the operating team. were matched to each other as regard age, sex, laboratory
Primary outcome was the conversion rate from laparo- and uS characteristics (Table 1).
s copic to open cholecystectomy. Secondary outcomes No mortality was recorded in either group. The mean
were duration of LC (measured from first incision to last duration of surgery was longer in group 2 than in group 1
skin suture), postoperative morbidity and hospital stay. (48.5 ± 11.6) vs (43 ± 10.4) but the result did not reach
Complications were recorded during the hospital stay and statistical significance. The conversion rates to an open
at the outpatient clinic, which every patient visited after procedure were 6.4 and 10.3% in groups I and II respec-
2 to 4 weeks. All patients were followed up for 6 months tively (Table 2). The main reasons for conversion were
and were instructed to notify the surgeon if there were any dense adhesions in Callot’s triangle, unclear anatomy and
symptoms suggesting biliary complication. bleeding from the gallbladder bed. The hospital stay was

Table 1: Patients’ characteristics
Variables Group I Group II p-value
Number of cases 31 29
Age (years) (mean ± SD) 46.2 ± 11.2 47.3 ± 11.1 0.7
Sex (female/male) 21/10 21/8 0.69
Proportion of abnormal LFTs (%) 25/31 (80%) 26/29 (89%) 0.3
US findings
• Dilated CBD diameter (˃ 8 mm) 29/31 (93.5%) 24/29 (8.2.7%) 0.19
• CBD stone (s) 28/31 (90%) 23/29 (79.3%) 0.23
LFTs: Liver function tests

Table 2: Patients’ outcomes
Variables Group I Group II p-value
Operative time (min) (mean ± SD) 43 ± 10.4 48.5 ± 11.6 0.057
Conversion rate 6.4% 10.3% 0.58
Length of hospital stay (days) (mean ± SD) 2.5 ± 1.5 4 ± 2 0.001
Postoperative complications
• Bleeding 0 1/29 (3.4%)
• Bile leak 1/31 (3.2%) 0
• Wound infection 0 1/29 (3.4%)
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