Laparoscopic Cholecystectomy within 24 Hours Following Endoscopic Retrograde Cholangiography as a Good Option for the Treatment of Cholecysto-Choledocholithiasis

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Background: Endoscopic retrograde cholangiopancreatography (ERCP) followed by laparoscopic cholecystectomy (LC) is a preferred treatment option for combined cholelithiasis and choledocholithiasis. Numerous studies have investigated the optimal timing of LC after ERCP, which can be early (within 72 hours) or delayed for 6 to 8 weeks. Objective: The aim of the current study is to evaluate the laparoscopic cholecystectomy within 24 hours following ERCP, as an option for the treatment of cholecysto-choledocholithiasis. Patients and methods: A total of 200 consecutive patients with combined cholelithiasis and choledocholithiasis, diagnosed by abdominal ultrasonography and magnetic resonance cholangiopancreatography, were included in our study. All patients underwent therapeutic ERCP, with sphincterotomy and stone extraction, followed by LC within 24 hours. The post-ERCP complications, the operative time, intraoperative blood loss, intraoperative severity of gall bladder adhesion, postoperative complications, and hospital stay were recorded and studied. Results: Among the 200 patients included, their mean age was 34 years. Of them 120 (60%) were females. Only 60 (30%) patients originally presented with biliary pancreatitis. Post-ERCP pancreatitis was recorded in 20 (10%) patients. The mean duration of laparoscopic cholecystectomy was 40 minutes (range 30-60) with minimal blood loss. Moderate to severe gall bladder adhesion was detected in 60 (30%) patients. In addition, intraoperative moderate to severe cholecystitis was detected in 80 (40%) patients. The post-cholecystectomy complications included ileus (N=10; 5%) and superficial wound sepsis (N=8; 4%). The mean hospital stay was 4 days (range 3-5). Conclusion: ERCP followed within 24 hours by laparoscopic cholecystectomy appears to be an effective choice for treating cholecysto-choledocholithiasis.

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