Optimal gap for laparoscopic cholecystectomy in choledochocystolithiasis after endoscopic retrograde cholangiopancreatography

Background Common bile duct stones were recorded in 10-18% of cases with gall bladder stones and vary in line with age. Almost 55% of those cases are symptomatic, and complications develop in half of them. Patients with choledochocystolithiasis may undergo immediate laparoscopic cholecystectomy (LC) after endoscopic retrograde cholangiopancreatography (ERCP) with endoscopic sphincterotomy (ES) in one setting, which is recommended, as it prevents recurrent complications of biliary tract and reduces morbidity and hospitalization, or undergo delayed LC after ERCP. The conversion from LC to open cholecystectomy after ES for choledochocystolithiasis reaches up to 20%, at least when LC was postponed for 4-8 weeks after ES. Aim To evaluate the advantages of early over delayed LC in patients with common bile duct stones regarding outcome, safety, and complications. Patients and methods This prospective randomized study was carried out from December 2018 to December 2020 at Department of General Surgery, and Department of Gastroenterology, Hepatology and Infectious Diseases, Al Azhar University Hospitals, Assiut, Egypt. It included 100 consecutive patients with cholelithiasis and choledocholithiasis who underwent LC after ERCP. All cases were classified into two groups. Group A included cases with choledochocystolithiasis that underwent immediate LC after ERCP, and group B included cases with choledochocystolithiasis that underwent delayed LC after ERCP. Results The duration of operation was much longer in group B (75.4 +/- 16.8, range: 40-90 min) than in group A (40 +/- 10, range: 30-45 min). The conversion rate was also significantly more incident in delayed group (21.8%). Conclusion The immediate LC after ERCP had better outcome than delayed LC after ERCP. It had lower conversion rate, less operative time, short hospitalization, and less postoperative complications.