Laparoscopic cholecystectomy with and without prior ERCP

ABSTRACT

To find out operative difficulties in patients undergoing laparoscopic cholecystectomy after ERCP in comparison with those without prior ERCP. Comparative study. Surgical Unit IV Civil Hospital Karachi, from June 2011 to June 2013. Patients were divided into 2 groups. Group 1 consisted of 40 patients with choledocholithiasis, who underwent ERCP followed by laparoscopic cholecystectomy while in Group 2 there were 40 patients with uncomplicated gallstones who had no intervention prior to laparoscopic cholecystectomy. A total of 80 patients underwent laparoscpic cholecystectomy. Male female ratio was 832 and 535 and mean age was 40.20 +/- 11.27 year and 39.58 +/- 11.29 year in Groups 1 and 2 respectively. Statistically significant difficulties were encountered during operation between the groups. Such difficulties were found in 29 [72.5%] and 3 [7.5%] patients in Group 1 and 2 respectively [p<0.0001]. The laparoscopic procedure was converted to open in eight [20%] patients in Group 1 and 1 [2.5%] patient in Group 2 [p=0.01]. Patients with difficult laparoscopic cholecystectomy had a mean ERCP frequency of 1.34 +/- 0.74 while those with no difficulty encountered had a mean ERCP frequency of 1.15 +/- 0.38 [p=0.05]. Statistically significant difference was found when comparing the operative difficulties encountered in patients who underwent ERCP and surgery in the same settings and in those where surgery was delayed after ERCP [p<0.001]. Laparoscopic cholecystectomy after ERCP was difficult and challenging. To minimize the complications and conversion, these patients should be operated in same sitting as for ERCP