Abstract
ABSTRACTObjective:To determine the period during which we should avoid cholecystectomy after endoscopic retrograde cholangiopancreatography.Methods:A retrospective analysis of electronic medical charts of 532 patients undergoing endoscopic retrograde cholangiopancreatography, between March 2013 and December 2017.Results:Approximately one-third of patients underwent the procedure between 4 and 30 days after endoscopic retrograde cholangiopancreatography. The conversion rate was 3.8%. The need for abdominal drainage and the finding of biliary tract injury after surgery were observed in 15.1% and 1.9% of patients, respectively. The length of stay was significantly shorter among patients undergoing surgery more than 30 days after endoscopic retrograde cholangiopancreatography. These patients had a median length of stay of one day, whereas the median length of stay in the group undergoing the procedure between 4 and 30 days after endoscopic retrograde cholangiopancreatography was 2 days.Conclusion:The period during which we should avoid cholecystectomy is between 4 and 30 days after endoscopic retrograde cholangiopancreatography.
Highlights
Cholecystectomy is the treatment of choice for cholelithiasis and acute cholecystitis; in case of stones lodged in the common bile duct, cholecystectomy requires additional exploration of the biliary tract.[1,2,3]
Endoscopic retrograde cholangiopancreatography (ERCP) is highly sensitive and specific for choledocholithiasis, but it is most frequently used after a confirmed diagnosis of choledocholithiasis, for therapeutic purposes.[3,5,6,7]
Studies show that laparoscopic cholecystectomy (LC) and ERCP, performed more than 72 hours apart, lead to inflammation of the biliary tract, which may hinder the use of laparoscopy to approach the gallbladder and biliary ducts.[20,21,22,23,24,25,26]
Summary
Cholecystectomy is the treatment of choice for cholelithiasis and acute cholecystitis; in case of stones lodged in the common bile duct, cholecystectomy requires additional exploration of the biliary tract.[1,2,3]. ERCP can be performed before, during or after cholecystectomy, and patients diagnosed with choledocholithiasis before surgical treatment or at high risk for complications, such as those with cholangitis or dilated biliary tree, must undergo preoperative ERCP. Lower-risk patients can undergo laparoscopic cholecystectomy with cholangiography and laparoscopic exploration of the common bile duct, depending on the surgeon’s skills and the equipment available at the hospital.[7,8,9,10,11,12]. Cholecystectomy must be performed safely, and inflammation resulting from the disease itself and manipulation during ERCP can hinder the surgery, increasing the operative time, the risk of bleeding and the conversion rate when compared with elective cholecystectomy without previous ERCP.[13,15,16,17,18,19]
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