Ann Hepatobiliary Pancreat Surg.  2023 Feb;27(1):20-27. 10.14701/ahbps.22-040.

Timing of laparoscopic cholecystectomy after endoscopic retrograde cholangiopancreatography in cholelithiasis patients: A systematic review and meta-analysis

• Poprom N
• Suragul W
• Muangkaew P
• Vassanasiri W
• Rungsakulkij N
• Mingphruedhi S
• Tangtawee P

• KMID: 2539510
• DOI: http://doi.org/10.14701/ahbps.22-040

Abstract

There are many variations and unclear definitions of the appropriate timing of laparoscopic cholecystectomy (LC) after endoscopic retrograde cholangiopancreatography (ERCP), and there is still a lack of consistency about the appropriate timing. Inappropriate timing can be associated with serious comorbidity and can affect the patients. This meta-analysis was conducted to assess the operative outcomes and morbidity to provide a benefit to the patients based on the best timing of LC after ERCP. Randomized controlled trials (RCTs) and retrospective studies were identified from the PubMed and Scopus databases from inception to July 2021. A meta-analysis was performed to estimate the treatment effects on operative outcomes and morbidity. Four RCTs and four retrospective studies met our inclusion criteria. A meta-analysis indicated that patients who received LC after ERCP on the same day or within 72 hours had about 0.354 days shorter length of hospital stay with a shorter operative time of about 0.111–1.835 minutes and a lower risk of complications around 37%–73%. Our evidence suggests that the appropriate timing of LC after ERCP is either the same day or within 72 hours for treating cholelithiasis patients based on the severity of disease.

Keyword

Laparoscopic cholecystectomy; Cholelithiasis; Endoscopic retrograde cholangiopancreatography; Meta-analysis

Figure

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  Fig. 1 Flow diagram for selection of studies. CBDS, concomitant common bile duct stones; RCT, randomized controlled trial.

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  Fig. 2 Pooled effect sizes of length of hospital stay in early laparoscopic cholecystectomy (LC) and late LC by the design. RCT, randomized controlled trial; SMD, standard mean different.

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  Fig. 3 Pooled effect sizes of the operative time in early laparoscopic cholecystectomy (LC) and late LC by the design. RCT, randomized controlled trial; SMD, standard mean different.

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  Fig. 4 Pooled effect sizes of complications in early laparoscopic cholecystectomy (LC) and late LC by the design. RCT, randomized controlled trial; RR, risk ratio.

Reference

1. Koc B, Karahan S, Adas G, Tutal F, Guven H, Ozsoy A. 2013; Comparison of laparoscopic common bile duct exploration and endoscopic retrograde cholangiopancreatography plus laparoscopic cholecystectomy for choledocholithiasis: a prospective randomized study. Am J Surg. 206:457–463. DOI: 10.1016/j.amjsurg.2013.02.004. PMID: 23871320.

2. Fink AS. 1993; Current dilemmas in management of common duct stones. Surg Endosc. 7:285–291. DOI: 10.1007/BF00725941. PMID: 8351597.

3. Schwab B, Hungness ES, Soper NJ. Yeo CJ, editor. 2019. Management of common bile duct stones. Shackelford’s Surgery of the Alimentary Tract. 8th ed. Philadelphia: Elsevier;p. 1286–1293.

4. El Nakeeb A, Ezzet H, Askar W, El Hanafy E, Hamdy E, Atef E, et al. 2016; Early versus late cholecystectomy after clearance of common bile duct stones by endoscopic retrograde cholangiopancreatography: a prospective randomized study. Surg Laparosc Endosc Percutan Tech. 26:202–207. DOI: 10.1097/SLE.0000000000000265. PMID: 27213785.

5. Esber EJ, Sherman S. 1996; The interface of endoscopic retrograde cholangiopancreatography and laparoscopic cholecystectomy. Gastrointest Endosc Clin N Am. 6:57–80. DOI: 10.1016/S1052-5157(18)30378-7.

6. Fulcher AS. 2002; MRCP and ERCP in the diagnosis of common bile duct stones. Gastrointest Endosc. 56(6 Suppl):S178–S182. DOI: 10.1067/mge.2002.129029. PMID: 12447264.

7. Sarli L, Iusco DR, Roncoroni L. 2003; Preoperative endoscopic sphincterotomy and laparoscopic cholecystectomy for the management of cholecystocholedocholithiasis: 10-year experience. World J Surg. 27:180–186. DOI: 10.1007/s00268-002-6456-8. PMID: 12616433.

8. Lakatos L, Simon L, Mester G, Réti G, Nagy A, Lakatos PL. 2004; [Selection criteria for preoperative endoscopic retrograde cholangiopancreatography before laparoscopic cholecystectomy. Results of a 7-year, retrospective, single center study]. Orv Hetil. 145:1553–1559. Hungarian.

9. Förster S, Klar E. 2008; [Common bile duct stones. Diagnostic and therapeutic management]. Chirurg. 79:881–892. German. DOI: 10.1007/s00104-008-1588-5. PMID: 18719863.

10. Ali RF, Aouf A, Isamil K, Ismail T, Elbatae H. 2021; Randomized controlled clinical trial of early vs delayed laparoscopic cholecystectomy after CBD stone clearance. Indian J Surg. 83:1158–1165. DOI: 10.1007/s12262-020-02607-y.

11. Muhammedoğlu B, Kale IT. 2020; Comparison of the safety and efficacy of single-stage endoscopic retrograde cholangiopancreatography plus laparoscopic cholecystectomy versus two-stage ERCP followed by laparoscopic cholecystectomy six-to-eight weeks later: a randomized controlled trial. Int J Surg. 76:37–44. DOI: 10.1016/j.ijsu.2020.02.021. PMID: 32105889.

12. Salman B, Yilmaz U, Kerem M, Bedirli A, Sare M, Sakrak O, et al. 2009; The timing of laparoscopic cholecystectomy after endoscopic retrograde cholangiopancreaticography in cholelithiasis coexisting with choledocholithiasis. J Hepatobiliary Pancreat Surg. 16:832–836. DOI: 10.1007/s00534-009-0169-4. PMID: 19701600.

13. Reinders JS, Goud A, Timmer R, Kruyt PM, Witteman BJ, Smakman N, et al. 2010; Early laparoscopic cholecystectomy improves outcomes after endoscopic sphincterotomy for choledochocystolithiasis. Gastroenterology. 138:2315–2320. Erratum in: Gastroenterology 2011;140:1361. DOI: 10.1053/j.gastro.2010.02.052. PMID: 20206179.

14. McAlister VC, Davenport E, Renouf E. 2007; Cholecystectomy deferral in patients with endoscopic sphincterotomy. Cochrane Database Syst Rev. 2007:CD006233. DOI: 10.1002/14651858.CD006233.

15. Ghazanfor R, Malik S, Tariq M, Changeez M, Malik J, Ghazanfor KR, et al. 2020; Impact of endoscopic retrograde cholangiopancreatography on laparoscopic cholecystectomy. J Islamabad Med Dental Coll. 9:48–53. DOI: 10.35787/jimdc.v9i1.383.

16. Sterne JA, Hernán MA, Reeves BC, Savović J, Berkman ND, Viswanathan M, et al. 2016; ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ. 355:i4919. DOI: 10.1136/bmj.i4919. PMID: 27733354. PMCID: PMC5062054.

17. Higgins JPT, Green S. 2011. Cochrane handbook for systematic reviews of interventions version 5.1.0 [updated March 2011]. The Cochrane Collaboration;Chichester:

18. Wild JL, Younus MJ, Torres D, Widom K, Leonard D, Dove J, et al. 2015; Same-day combined endoscopic retrograde cholangiopancreatography and cholecystectomy: achievable and minimizes costs. J Trauma Acute Care Surg. 78:503–507. discussion 507–509. DOI: 10.1097/TA.0000000000000552. PMID: 25710419.

19. Passi M, Inamdar S, Hersch D, Dowling O, Sejpal DV, Trindade AJ. 2018; Inpatient choledocholithiasis requiring ERCP and cholecystectomy: outcomes of a combined single inpatient procedure versus separate-session procedures. J Gastrointest Surg. 22:451–459. DOI: 10.1007/s11605-017-3588-6. PMID: 28971298.

20. Al-Temimi MH, Trujillo C, Shah M, Rangarajan S, Kim E, Chandrasekaran B, et al. 2018; Same-day versus conventional different-day endoscopic retrograde cholangiopancreatography and laparoscopic cholecystectomy: a multi-center retrospective study. Am Surg. 84:1679–1683. DOI: 10.1177/000313481808401029. PMID: 30747694.

21. Aziret M, Karaman K, Ercan M, Vargöl E, Toka B, Arslan Y, et al. 2019; Early laparoscopic cholecystectomy is associated with less risk of complications after the removal of common bile duct stones by endoscopic retrograde cholangiopancreatography. Turk J Gastroenterol. 30:336–344. DOI: 10.5152/tjg.2018.18272. PMID: 30945646. PMCID: PMC6453651.

22. Takada T. Tokyo Guidelines 2018: updated Tokyo Guidelines for the management of acute cholangitis/acute cholecystitis. J Hepatobiliary Pancreat Sci. 2018; 25:1–2. DOI: 10.1002/jhbp.526. PMID: 29334699.

23. De Santis L. 2013; ERCP and laparoscopic cholecystectomy in a combined (one-step) procedure with a novel technique. BMC Surg. 13:A15. DOI: 10.1186/1471-2482-13-S1-A15. PMCID: PMC3847213.

24. Bostanci EB, Ercan M, Ozer I, Teke Z, Parlak E, Akoglu M. 2010; Timing of elective laparoscopic cholecystectomy after endoscopic retrograde cholangiopancreaticography with sphincterotomy: a prospective observational study of 308 patients. Langenbecks Arch Surg. 395:661–666. DOI: 10.1007/s00423-010-0653-y. PMID: 20526779.