Difficulty of Delayed Laparoscopic Cholecystectomy After Endoscopic Retrograde Cholangiography Management of Choledocholithiasis

Abstract

Aim: Common bile duct stones (CBDS) management consists of CBD clearance. Since, in most cases, CBDS are due to gallstone migration, there is also a formal indication for cholecystectomy. Timing for endoscopic retrograde cholangiography (ERC) is a matter of debate, as it may be performed before, after, or even during cholecystectomy, according to the so-called “rendez-vous technique”. This retrospective study is aimed to evaluate the difficulty of laparoscopic cholecystectomy (LC) done after more than 2 weeks period for patients underwent ERC to manage CBDS. Methods: The present study enrolled 99 (69 males and 30 females) patients, whom suffered from CBD stones. The patients were revised and the clinical records were presented at the National Hepatology and Tropical Medicine Research Institute (NHTMRI) - at surgery department, from May 2012 to November 2014. Results: Preoperative jaundice was positive in 33 patients (total serum bilirubin > 2 mg/dL), ERC was done to all patients and stent was placed in 24 patients. Surgery (LC) was delayed more than 2 weeks due to unfitness for surgery 24, patient reluctance 27, and long waiting list 48 patients. During LC different grades of adhesions at Callot’s triangle were reported as; grade I in 27, grade II in 42, grade III in18, and grade IV in 12. Conversion to open surgery occurred in 33 patients. Mortality occurred in 3 patients and morbidity in 30 patients. Conclusion: Concomitant or early LC (within 1 week) after ERC for CBDS is strongly recommended, otherwise, a high surgical expertise is advised to perform the procedure after that period.