A study to assess the outcome of patients undergoing laparoscopic cholecystectomy post ERCP

Abstract

Background: Choledocholithiasis is prevalent in 8 to 20 percent of patients with cholelithiasis. Of all the treatment options available, laparoscopic cholecystectomy post ERCP is one of the most commonly used modality. Surgeons have always experienced difficulties while performing a laparoscopic cholecystectomy post ERCP due to adhesions induced by ERCP. This study was to investigate this modality further to assess the difficulty during the procedure and the possible factors influencing this. Methods: Patients post ERCP who underwent interval laparoscopic cholecystectomy was studied in a tertiary care centre in the urban setting. Results: Out of the 40 patients studied over the 18 month period, 14 (35%) underwent conversion to open cholecystectomy. Calot’s triangle adhesions were the most common cause of conversion. Multiple ERCP sessions positively influenced the chance of conversion (P-value 0.014). Intraoperative bleeding was directly related to the Calot’s triangle adhesions which subsequently increased the chance of post-operative bile leak (P-value 0.022). No mortalities were encountered during the course of the study. Conclusions: Laparoscopic cholecystectomy in post ERCP patients is difficult but safe.