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Cholecystectomy after endoscopic retrograde cholangiopancreatography – effect of time on treatment outcomes

Justyna Kostro, Iwona Marek, Rafał Pęksa, Dariusz Łaski, Andrzej Hellmann, Jarek Kobiela, Stanisław Hać, Joanna Pieńkowska, Krystian Adrych, Zbigniew Śledziński

Data publikacji online: 2018/09/17
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Cholelithiasis is one of the most common diseases worldwide. It is also a cause of at least one million hospitalisations and more than 700,000 surgical procedures annually in the USA [1]. Although the mortality rate for this disease is relatively low (0.6%), it is associated with the possibility of a variety of complications [1]. Choledocholithiasis occurs in 10–18% of patients with cholelithiasis and varies according to age [2]. Nearly 55% of patients are symptomatic, and half of those experience complications [3]. Currently, laparoscopic cholecystectomy (LC) is the gold standard treatment for cholecystolithiasis, while endoscopic retrograde cholangiopancreatography (ERCP) with endoscopic sphincterotomy (ES) is the approach commonly used to clear stones from the common bile duct (CBD). There are still discussions about the order in which ERCP and LC should be performed, as well as the timing between the two procedures. Most authors share the opinion that LC should be performed shortly after ERCP [4–9]. A randomised trial has suggested that early LC (within 72 h) appears to be safe and may prevent the majority of biliary events in the period following sphincterotomy [10]. A prospective, randomised, multicentre trial confirmed that a wait-and-see policy after endoscopic sphincterotomy combined with cholecysto-choledocholithiasis cannot be recommended as a standard approach after cholecystectomy [11]. Moreover, a delay of LC has been correlated with a higher incidence of cholangitis. Patients with infected bile ducts can develop complications, such as cholecystitis or recurrent choledocholithiasis [12]. An analysis of histopathological data, combined with surgical outcomes, can be performed before any definitive conclusions can be made [13].
The aim of the present study was to estimate the impact of timing between the procedures and the indication for ERCP in terms of cholecystectomy, postoperative complications, and gallbladder inflammation.
The medical records of patients treated in our hospital for symptomatic CBD stones per 6 years were retrospectively analysed. All patients who underwent ERCP and cholecystectomy in our hospital were analysed. The patients were divide into two groups: the patients in group A had complications such as pancreatitis, cholangitis, Mirizzi’s syndrome, acute cholecystitis, and repeated ERCP before LC, and the patients in group B had uncomplicated cholecysto-choledocholithiasis. Both groups were...

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