Laparoscopic Cholecystectomy with Intraoperative Endoscopic Retrograde Cholangiopancreatography as a Combo Approach under Standardized Balanced General Anesthesia for the Management of Cholecysto-Choledocholithiasis: A Retrospective Study.

ABSTRACT

Background: Cholecystolithiasis and choledocholithiasis combinedly known as or simply cholelithiases is of common occurrence with a worldwide incidence of about 10%. Though numerous treatment options are available but with the advent of minimally invasive techniques and endoscopic retrograde cholangiopancreatography (ERCP), laparoscopic cholecystectomy (LC) with intraoperative ERCP (IO-ERCP) are the most recent researched technique so far. Objective: This study was done to assess the efficacy of LC with IO-ERCP for the management of cholecysto-choledocholithiases under protocolized balanced anesthesia. Methods: This retrospective study was conducted at a tertiary level hospital on 400 patients from 2008 to 2014. The patient selection was based on clinical presentations, laboratory investigations, and ultrasonography and magnetic resonance cholangiopancreatography imaging with positive evidence of gall bladder stones along with common bile duct (CBD) stones. Under general anesthesia as per standardized hospital protocol in all cases by conventional 4 port laparoscopic approach CBD was accessed, transcystically cannulated followed by IO-ERCP and completion of cholecystectomy. Results: Out of 400 patients, LC + IO-ERCP was successful in 304 cases. Neither the post-operative (PO) recovery was delayed nor was eventful. PO complications were also insignificant though we encountered a single case of post-ERCP pancreatitis, but that was one of those cases where we failed to accomplish IO-ERCP, instead had to settle with post-LC ERCP in the same setting. Average operation time was 116.84 ± 14.46, and the average duration of hospital stay was 2.15 ± 0.54. Conclusion: The combo procedure of LC IO-ERCP was found to be very efficacious owing to less number of hospitalizations, shortened hospital stay, reduced chances of PO complication, decreased risks of anesthesia hence, both times saving, as well as cost effective with overall patient satisfaction.