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OPTIMUM TIMING OF LAPAROSCOPIC CHOLECYSTECTOMY AFTER ERCP & STENTING IN PATIENTS OF CHOLELITHIASIS WITH CHOLEDOCHOLOITHIASIS: A PROSPECTIVE RANDOMISED STUDY
Saurabh Galodha, Mokshal Shah
*AIIMS, All India Institute of Medical Sciences, New Delhi, Delhi, IN, academic/medsch, New Delhi, Delhi, India
IntroductionThe optimal timing of Laparoscopic Cholecystectomy post ERCP stenting has not been clearly established in patients of
cholelithiasis with choledocholithiasis and we have tried to ascertain this in our study.
MethodsPatients who underwent ERCP prior to LC from 1st July 2019 to 30th June 2020 divided into three groups; immediate (<24 h)(A), early
(24-72 h)(B) and delayed (6 weeks)(C) on interval between LC and ERCP. 1:1:1 randomisation performed.
Demographic and intraoperative parameters, perioperative morbidity and hospital stay were analysed.
ResultsSixty-three patients (21 in three groups) included in the study. Two patients with post ERCP pancreatitis switched from group B to C.
Mean age was 48.43 ± 15.13 years. Group C had more females (57.1% vs. 42.1% vs. 87% respectively) (p= 0.008). A significantly less mean
operative time and mean blood loss in group A (37.14 ± 9.84 vs. 44.37 ± 7.61 vs. 49.48 ± 12.60 min) (p=0.001) & (25.48±16.03 vs.
32.89±17.10 vs. 48.70 ±16.73 ml) (p <0.001). Commonest intraoperative complication was bleeding (n=12,19.0%),highest in group C.
Postoperative complications were seen in 25(39.6%) patients (4 vs. 8 vs. 13 patients in groups A, B & C) (p=0.410).
Median hospital stay was 2 vs. 4 vs. 7 days in the three groups respectively (p=0.006).
ConclusionIn patients with cholelithiasis with choledocholithiasis it is best to perform LC in same sitting with ERCP clearance & stenting. Logistical issues may arise in this case. However, they are offset by the public health implications of a dramatically reduced hospital stay. Other advantaged include ease of dissection and a lower complication rate.
Distended bowel in immediate laparoscopic cholecystectomy
Dense pericholecystic adhesions in delayed laparoscopic cholecystectomy
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