Abstract
Objective: Published literature so far has supported the fact that patients who underwent endoscopic retrograde cholangio-pancreatography and sphincterotomy (ERCPS) had a difficult perioperative course after subsequent laparoscopic cholecystectomy. Through a retrospective study, this original report mentions statistics in a Southeast Asian population comparing the effect on conversion to open surgery in patients undergoing laparoscopic cholecystectomy after ERCPS in a university hospital in Sri Lanka.Methods: The results of 205 patients who underwent laparoscopic cholecystectomy and 85 patients who were converted to open surgery between 2016 and 2018 were analyzed to find out whether ERCPS is a risk factor for conversion or subsequent perioperative morbidity.Results: Demographics like age, gender and previous abdominal surgeries were comparable between the two groups. Cholecysto-choledocholithiasis and undergoing ERCPS for it were significant factors associated with conversion to open cholecystectomy.Conclusion: Performing laparoscopic cholecystectomy after ERCPS for cholecysto-choledocholithiasis is a significant challenge and preferably should be often handled by a more experienced surgeon.
Highlights
Endoscopic retrograde cholangio-pancreatography and sphincterotomy (ERCPS) followed by laparoscopic cholecystectomy is the preferred management protocol in patients with combined cholecystocholedocholithiasis
Distributions of age, gender and previous abdominal surgeries were comparable between Laparoscopic Cholecystectomy (LC) and Laparoscopic c/t Open Cholecystectomy (LOC) groups (Table 1)
Data indicated that patients who are subjected to LC post-ERCPS for cholecysto-choledocholithiasis are at significant risk of higher chances to proceed to open cholecystectomy and subsequently a difficult surgery during the intraoperative period
Summary
Endoscopic retrograde cholangio-pancreatography and sphincterotomy (ERCPS) followed by laparoscopic cholecystectomy is the preferred management protocol in patients with combined cholecystocholedocholithiasis. The sequelae to open procedure after a previous ERCPS has been documented to be in the range of 8-55% compared to
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