ORIGINAL ARTICLES   

Chirurgia 2004 February;17(1):15-8

Copyright © 2004 EDIZIONI MINERVA MEDICA

language: English

Laparoscopic cholecystectomy after endoscopic retrograde cholangiopancreatography for cholecystocholedocholithiasis: the sooner the better

Busic Z., Servis D., Stipancic I., Busic V., Amic E.

Aim. Although a reliable endoscopic method for the treatment of cholecystocholedocholithiasis has been developed, it is technically difficult to perform and so it remains confined to small number of hospitals. The golden standard for the treatment of cholecystocholedocholithiasis still remains laparoscopic cholecystectomy (LC) with perioperative endoscopic sphincterotomy and common bile duct stone extraction. The success rates of both methods are comparable, but the latter is technically not as demanding. In this study we analyzed the impact of the interval length between endoscopic sphincterotomy and LC on length of hospitalization and consumption of analgesics and antibiotics.
Methods. We prospectively analyzed all the patients admitted on Department of Abdominal Surgery II, University Hospital Du-brava, Zagreb, Croatia, for cholecystolithiasis between 1-1-2000 and 31-12-2002. Among them, 37 patients had obstructive jaundice due to choledocholithiasis.
Results. In 5 cases endoscopic retrograde cholangiopancreatography (ERCP) was not feasible. Of 32 successfully performed endoscopic sphincterotomies, common bile duct stone extraction was not successful in 12 cases (37%), mostly because of concrement size. In those cases open surgery was performed (open approach). Out of 20 cases with successful common bile duct stone extraction, in 17 cases we subsequently performed LC (combined approach). The morbidity in the open approach group was 35% and in the combined approach group 15%. As expected, the combined approach group had shorter hospitalization (p<0.001) and needed less antibiotics (p<0.05). We further grouped cases treated with combined approach according to the interval between ERCP and laparoscopic sphincterotomy, whether they were operated within the first 24 hours after ERCP or later. We determined that the group operated within the first 24 hours had shorter hospitalization (p<0.0001), and needed less antibiotics (p<0.001) and analgesics (p=0.001) than the group operated later.
Conclusion. It is beneficial for both the patients and the hospital to perform LC within the first 24 hours after ERCP.