Early Cholecystectomy Versus Late Cholecystectomy in Choledocholithiasis following Endoscopic Retrograde Cholangiopancreaticography.

Corresponding Author:
Dr. Varun Dogra,
Department of Surgery,
Government Medical College,
Jammu-180001, Bakshi Nagar,
Jammu and Kashmir, India.
E-mail: drdogravarun@gmail.com

ABSTRACT

BACKGROUND
It is hypothesized that early planned laparoscopic cholecystectomy after endoscopic sphincterotomy prevents recurrent biliary complications and reduces operative morbidity and hospital stay. The aim of our study is to look for advantages of early cholecystectomy over late laparoscopic cholecystectomy in post ERCP patients at Government Medical College, Jammu.

METHODS

This is a prospective study conducted at Department of Surgery at Government Medical College and Hospital, Jammu from January 2018 to December 2018. All the patients who underwent laparoscopic cholecystectomies after ERCP for CBD calculi were included in study and were categorized into two groups according to time interval between ERCP and Laparoscopic Cholecystectomy. Outcomes were compared on the basis of operating time, conversion to open cholecystectomy, intra op bleeding requiring transfusion, and hospital stay and post op complications such as infection, CBD injury, pancreatitis.

RESULTS

Thirty patients were included in this study, who presented with the features suggestive of cholelithiasis with choledocholithiasis. Of those, 19 were subjected to early laparoscopic cholecystectomy following ERCP and 11 were subjected to late laparoscopic cholecystectomy. A comparative study was performed which showed that a shorter interval is associated with lesser conversion rate, lesser post-operative blood transfusion, lesser wound infections with less operating time which is a surrogate marker for lesser intraoperative adhesions and other complications. Shorter interval is also associated with decreased hospital stay which depicts lesser burden on hospital resources and on mean expenses.

CONCLUSIONS

Short interval between endoscopic retrograde cholangiopancreatography and laparoscopic cholecystectomy is safe and effective method of treating cholelithiasis associated with choledocholithiasis. However, a larger sample size must be studied for a longer period of time to confirm the findings of this study.

KEY WORDS

Choledocholithiasis, Endoscopic Retrograde Cholangiopancreatography, Laparoscopic Cholecystectomy.