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IS LAPAROSCOPIC CHOLECYSTECTOMY PERFORMED EARLY AFTER BILE DUCT CLEARANCE IN A TERTIARY HOSPITAL IN THE MIDDLE EAST?

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IS LAPAROSCOPIC CHOLECYSTECTOMY PERFORMED EARLY AFTER BILE DUCT CLEARANCE IN A TERTIARY HOSPITAL IN THE MIDDLE EAST?

Sara Kanfar, Mosa AlZahrani, Abdullah AlKhaldi, Mohammed Abaaljaysh, Mohamed AlNaiem, Ayman Abouleid

King Fahad Military Medical Complex, Dhahran, Saudi Arabia


Background:

  • The prevalence of common bile duct stones (CBDS) in patients with symptomatic gallstones is between 10-20% [1]
  • 40-50% of patients with Jaundice will have CBDS [2]
  • Recent guidelines recommend that the clearance of common bile duct stones should be preceded or followed by laparoscopic cholecystectomy.
  • ERCP is an effective minimally invasive technique for bile duct clearance in up to 97% of patients. [3]
  • Some studies show that the longer the interval between ERCP and Laparoscopic Cholecystectomy the higher incidence of complications and conversion rate. [4]
  • Other studies show no difference in outcome [5]


Aim:

  • The aim of the study is to evaluate our practice in offering early cholecystectomy (EC) after bile duct clearance for patients with obstructive jaundice or biliary pancreatitis
Method:
  • Retrospective analysis of prospectively maintained data of all patients who had laparoscopic cholecystectomy after bile duct clearance in a tertiary hospital in the middle east between January 2016 - December 2017
  • EC is defined as laparoscopic cholecystectomy done in the same setting or within one week after endoscopic bile duct clearance
Results:
  • Sample Size n=74
    • 41 (55.4%) Underwent Endoscopic clearance
    • 33 (44.6%) Spontaneously passed the stone 
  • Out of the 41 patients who underwent clearance: 
    • 27 (65.9%) had early cholecystectomy
    • 14 (34.1%) had delayed cholecystectomy
  • Post-operative complications, conversion rate and re-admissions were zero in both groups
Conclusion:
  • Early laparoscopic cholecystectomy is performed within one week after endoscopic bile duct clearance in most of the cases of biliary obstructive jaundice and biliary pancreatitis in a tertiary hospital in the Middle East but with longer hospitals stay. 
  • No Significant differences between both groups in regard to conversion rate, complication and re-admission 
  • More efforts are needed to improve the service to offer early cholecystectomy after bile duct clearance.
References:
  1. Williams E, Beckingham I, El Sayed G, et alUpdated guideline on the management of common bile duct stones (CBDS)Gut 2017;66:765-782.
  2. Thomas NG, Joseph F, Amaral. Timing of Endoscopic Retrograde Cholangiopancreatography and Laparoscopic Cholecystectomy in the Treatment of Choledocholelithiasis. J Laparoendosc Adv Surg Tech A. 1999 Feb;9(1):31-7
  3. Ko CW, Lee SP. Epidemiology and natural history of common bile duct stones and prediction of disease. Gastrointest Endosc. 2002; 56: 165- 169.
  4. Ghnnam WM (2016) Early Versus Delayed Laparoscopic Cholecystectomy Post Endoscopic Retrograde Cholangio Pancreatography (ERCP). JSM Gen Surg Cases Images 1(2): 1006.
  5. Ammar SA, Bar MA, El Shafy M. Laparoscopic Cholecystectomy after Endoscopic Retrograde Cholangiopancreatography; The Optimal Timing for Operation. World J Lap Surg 2014;7(2):69-73.


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