Outcome in Patients Undergoing Laparoscopic Cholecystectomy Following ERCP; Does Timing of Surgery Really Matter

Laparoscopic cholecystectomy (LC) is the gold standard treatment for cholelithiasis. Objectives: Our study intended to evaluate whether timing of surgery is of any influence on the course of the laparoscopic cholecystectomy (LC) following Endoscopic Retrograde Cholangio-Pancreatography ERCP/Endoscopic sphincterotomy (ES) and to identify and assess various factors that can affect the outcome in these patients. Patients and Methods: Data of 77 patients treated for choledochocystolithiasis with ERCP/ES followed by LC were reviewed. Patients were classified into four groups, group A (n = 29): LC performed within 24 hours after ERCP; group B (n = 20): LC performed after 24 hours to 7 days; group C (n = 12): LC done between 8 to 28 days; group D (n = 16): LC done after 28 days of ERCP. Primary outcome was operating time and secondary outcomes included intra- or post-operative complications, hospital stay and hospital expenses. Results: Mean operative time was shortest in group A (57.1 minutes) and longest in group B [63.4 (P = 0.131)]. Mean hospital stay was shortest in group A (2.1 days) and longest in group C (5.7 days) (P = 0.003). Hospital expenses were minimal in group A (P = 0.001). Male sex, serum bilirubin level, White blood cell (WBC) count, duration of ERCP/ES procedure, contracted gall bladder and large calculus size on Ultrasonography (USG) were significantly associated with primary outcome. Conclusions: LC can be performed within 24 hours of ERCP/ES with favorable outcome and less expenses. Timing of LC after ERCP/ES is not significantly associated with outcome of the procedure. Male sex, serum bilirubin level, WBC count, ERCP/ES procedure duration, contracted gall bladder and large size of gall bladder calculus on imaging are significantly associated with difficulty in surgery.