One Stage ERCP Plus Laparoscopic Cholecystectomy (Intra-Operative ERCP) Procedure versus Two Stage Approach (Pre-Operative ERCP Followed by Laparoscopic Cholecystectomy) for the Management of Symptomatic Cholelithiasis with Suspected CBD Stones

Abstract

BACKGROUND:Choledocholithiasis is a prevalent clinical disease, with symptomatic cholelithiasis occurring in 10%–20% of people, 7–14% of cholecystectomy patients, and 18–33% of patients with acute biliary pancreatitis. Endoscopic retrograde cholangiopancreatography (ERCP) and laparoscopic cholecystectomy (LC) are the best options for concurrent gallstones and common bile duct stones.

AIM: This study aimed to evaluate the safety and effectiveness of managing Choledocholithiasis in one stage (ERCP + laparoscopic cholecystectomy) compared to two-stage procedures (ERCP followed by laparoscopic cholecystectomy in two different anesthesia).The advantage of a one-stage operation was that it reduced the number of complications, the length of anesthesia/procedure, hospital stay, and overall morbidity and mortality.

METHODOLOGY:The sample size of 179 Patients with symptomatic gallstones underwent ERCP and laparoscopic cholecystectomy in a tertiary care hospital in Karachi from December 2012 to December 2014, out of which 41 patients went through single-stage management under general anesthesia, while 138 patients treated with sequential ERCP and laparoscopic cholecystectomy.

RESULTS:Cholelithiasis was suspected in 179 patients that underwent ERCP and laparoscopic cholecystectomy, and the results were compared from two-stage procedures to the one-stage procedure in which there is no need for multiple anesthesia sessions also; therefore, the success rate was found high in a one-stage group (95%) as compared to a two-stage group while fewer complications were seen when patients are going through one-stage management. Independent t-test and chi-square test were performed, and a value <0.05 was taken as significant.The success rate was significantly high in the stage one group than in the stage two group (p= 0.03). The mean operative time in the stage two group (3.38 hours) was longer than the stage one group (2.24 hours), and it was found to be highly significant (p= 0.000). The mean length of hospital stay was also found significant in our study as stage one had a mean length of hospital stay of 1.71 days while stage two had 3.46 days (p= 0.000).

CONCLUSION: This study proved that this modified technique, i.e., one-stage ERCP combining laparoscopic cholecystectomy, can effectively reduce the number of complications, thereby increasing the success rate and reducing operative time and hospital stay, reducing hospital expenses.