Is Immediate Laparoscopic Cholecystectomy after ERCP a Safe Treatment for Gallstone Complications?

Abstract

Background: Laparoscopic cholecystectomy (LC) after endoscopic retrograde cholangiopancreatography (ERCP) is a standard treatment for patients with complicated cholelithiasis. Currently, there is no conclusion about the optimal interval between LC and ERCP, especially in the case of emergent ERCP. Objective: The purpose of this study is to compare the outcome of patients treated with immediate, early, and delayed LC after ERCP. Materials and Methods: A total of 198 patients who received LC and ERCP between July 2017 and June 2019 were retrospectively reviewed. Patients were divided into 3 groups: immediate (single-staged LC with ERCP – 109 patients), early (LC <72 hr after ERCP – 20 patients) and delayed (LC >72 hr after ERCP – 69 patients). Patient demographics and primary endpoints (conversion rate to open cholecystectomy (OC), blood loss, operative time, complications, mortality and length of hospital stay) were recorded. The secondary endpoint was to analyze factors that influence the conversion to OC. Results: There were no statistical differences in the conversion rate (p=0.921) and major complications (p=0.548) between all three groups. However, the immediate group demonstrated shorter length of post-ERCP hospital stay than other groups (p=0.0001). The analysis of emergent ERCP cases showed no difference in the conversion rate and major complications (p=0.999 and 0.329). Patients with a history of previous ERCP tend to convert to OC but the difference was not statistically significant in the multivariate analysis (p=0.106). Conclusion: Performing LC immediately after ERCP is safe, does not increase the conversion rate, and results in shorter hospital stays even in emergent ERCP cases.