Endoscopic Sphincterotomy for Cholecysto-Choledocholithiasis Complicates Subsequent Laparoscopic Cholecystectomy: A Retrospective Report From Sri Lanka

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.

Comparative analysis of laparoscopic choledocholithiasis and ERCP treatment after cholecystectomy

“…Currently, the known incidence of recurrent common bile duct stones after undergoing ERCP ranges from 7–21% [ 3 ]. The main cause of recurrent common bile duct stone development after ERCP is the reflux of duodenal contents into the biliary system, leading to bacterial colonization and subsequent stone formation [ 2 , 4 , 5 ]. Studies have shown that excessively large or numerous common bile duct stones can lead to the failure of ERCP procedures, resulting in unnecessary financial and psychological burden for patients [ 6 ].…”