Comparison of clinical outcomes of early versus delayed laparoscopic cholecystectomy after endoscopic retrograde cholangiopancreatography in patients with common bile duct stones: A retrospective cohort study
Keywords:
bile duct injury, early laparoscopic cholecystectomy, delayed LC, common bile duct stone, endoscopic retrograde cholangiopancreatographyAbstract
Introduction: Distal common bile duct (CBD) stone is mostly managed by endoscopic retrograde cholangiopancreatography (ERCP) followed by either promptly laparoscopic cholecystectomy (LC) or delayed fashion. However, there is no consensus guideline in timing of LC after ERCP in CBD stones patient.
Objective: This study aims to compare the clinical outcomes between early and delayed LC following ERCP in patients with CBD stones at Nakornping hospital.
Study Methods: A retrospective, observational study was conducted in patients aged 18 to 80 years who underwent elective laparoscopic cholecystectomy (LC) after endoscopic retrograde cholangiopancreatography (ERCP) at Nakornping Hospital between June 2021 and December 2023. Patients were divided into early LC (within 72 hours after ERCP) and delayed LC (more than 72 hours after ERCP). The primary endpoint was the occurrence of bile duct injury (BDI) and secondary endpoints were intraoperative complications. Data analysis was presented as risk differences with 95% confidence intervals. Secondary endpoints included length of hospital stay, and Delphi’s difficulty score, the results were presented as mean differences with 95% CI.
Results: A total of 84 patients who underwent elective laparoscopic cholecystectomy (LC) after ERCP were retrospectively analyzed, with 43 patients (51.2%) in the early LC group and 41 (48.8%) in the delayed LC group. The analysis indicated that early LC was comparable to delayed LC in terms of bile duct injury (BDI), with a risk difference of -2.44% (95% CI: -2.23 to 7.16). The secondary outcome of patients in the early LC group had a statistically significant reduction in overall hospital stay compared to those in the delayed group; mean difference: -2.48 days; 95% CI: -3.62 to -1.33; p < 0.001 while other outcomes had no difference between groups including the Delphi’s difficulty score; mean difference: -0.28; 95% CI: -2.15 to 1.60; p = 0.770.
Conclusion: Early LC was comparable to delayed LC concerning BDI and Delphi’s difficulty score. In addition, early LC subsequently to ERCP-induced stone extraction demonstrated significantly shorter overall length of hospital stay. Therefore, it is preferred when feasible.
References
Figueiredo JC, Haiman C, Porcel J, Buxbaum J, Stram D, Tambe N, et al. Sex and ethnic/racial-specific risk factors for gallbladder disease. BMC Gastroenterol. 2017;17(1):153. doi: 10.1186/s12876-017-0678-6.
Tazuma S. Gallstone disease: Epidemiology, pathogenesis, and classification of biliary stones (common bile duct and intrahepatic). Best Pract Res Clin Gastroenterol. 2006;20(6):1075-83. doi: 10.1016/j.bpg.2006.05.009.
Stinton LM, Shaffer EA. Epidemiology of gallbladder disease: cholelithiasis and cancer. Gut Liver. 2012;6(2):172-87. doi: 10.5009/gnl.2012.6.2.172.
Mann K, Belgaumkar AP, Singh S. Post-endoscopic retrograde cholangiography laparoscopic cholecystectomy: challenging but safe. JSLS. 2013;17(3):371-5. doi: 10.4293/108680813X13654754535511.
Williams E, Beckingham I, El Sayed G, Gurusamy K, Sturgess R, Webster G, Young T. Updated guideline on the management of common bile duct stones (CBDS). Gut. 2017;66(5):765-82. doi: 10.1136/gutjnl-2016-312317.
Buxbaum JL, Abbas Fehmi SM, Sultan S, Fishman DS, Qumseya BJ, Cortessis VK, et al. ASGE guideline on the role of endoscopy in the evaluation and management of choledocholithiasis. Gastrointest Endosc. 2019;89(6):1075-105.e15. doi: 10.1016/j.gie.2018.10.001.
Wada K, Takada T, Kawarada Y, Nimura Y, Miura F, Yoshida M, et al. Diagnostic criteria and severity assessment of acute cholangitis: Tokyo Guidelines. J Hepatobiliary Pancreat Surg. 2007;14(1):52-8. doi: 10.1007/s00534-006-1156-7.
Kiriyama S, Kozaka K, Takada T, Strasberg SM, Pitt HA, Gabata T, et al. Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholangitis (with videos). J Hepatobiliary Pancreat Sci. 2018;25(1):17-30. doi: 10.1002/jhbp.512.
Wakabayashi G, Iwashita Y, Hibi T, Takada T, Strasberg SM, Asbun HJ, et al. Tokyo Guidelines 2018: surgical management of acute cholecystitis: safe steps in laparoscopic cholecystectomy for acute cholecystitis (with videos). J Hepatobiliary Pancreat Sci. 2018;25(1):73-86. doi: 10.1002/jhbp.517.
Poprom N, Suragul W, Muangkaew P, Vassanasiri W, Rungsakulkij N, Mingphruedhi S, et al. Timing of laparoscopic cholecystectomy after endoscopic retrograde cholangiopancreatography in cholelithiasis patients: A systematic review and meta-analysis. Ann Hepatobiliary Pancreat Surg. 2023;27(1):20-7. doi: 10.14701/ahbps.22-040.
Aziret M, Karaman K, Ercan M, Vargöl E, Toka B, Arslan Y, et al. Early laparoscopic cholecystectomy is associated with less risk of complications after the removal of common bile duct stones by endoscopic retrograde cholangiopancreatography. Turk J Gastroenterol. 2019;30(4):336-44. doi: 10.5152/tjg.2018.18272.
Gao MJ, Jiang ZL. Effects of the timing of laparoscopic cholecystectomy after endoscopic retrograde cholangiopancreatography on liver, bile, and inflammatory indices and cholecysto-choledocholithiasis patient prognoses. Clinics (Sao Paulo). 2021;76:e2189. doi: 10.6061/clinics/2021/e2189.
da Costa DW, Bouwense SA, Schepers NJ, Besselink MG, van Santvoort HC, van Brunschot S, et al. Same-admission versus interval cholecystectomy for mild gallstone pancreatitis (PONCHO): a multicentre randomised controlled trial. Lancet. 2015;386(10000):1261-8. doi: 10.1016/S0140-6736(15)00274-3.
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