Is ERCP aided by trans-cystic wire during laparoscopic cholecystectomy safer and faster than if performed separately?

Wesley B Jones, MDMS, Mathew T Epps, MDMS. Greenville Health System

In a previous study we showed that diagnostic ERCP performed either before or after laparoscopic cholecystectomy (LC) had a significant rate of pancreatitis and unnecessary procedures. Therefore, we have begun using intra-operative ERCP in the event of positive cholangiography to limit the use of diagnostic ERCP. To aid in cannulation of the ampulla a wire was passed down the cystic duct into the duodenum at the time of LC. We hypothesized that this would lead to shorter total operative times, less complications, and fewer unnecessary procedures. The purpose of our study was to test that hypothesis, comparing those patients who had intra-operative ERCP to those who had ERCP separately from LC. We performed a retrospective review from a prospective database of 987 patients who had ERCP by a single surgeon between July 2011 and July 2014. Patients who had single-stage laparo-endoscopic rendezvous (LERV) were compared to those who had a two-staged approach with ERCP either before or after LC. Variables examined included: incidence of unnecessary procedures, time to complete ERCP, total operative time, post-procedural pancreatitis (PEP), and hospital length of stay (LOS). In total 152 patients were included in the study (29 in the LERV group and 123 in the two staged approach group). Fifty-seven patients had their LC at outside facilities. There were significantly fewer unnecessary procedures in the LERV group (0%) compared to the two-staged approach (15.5% p=0.025). Total operative time was significantly greater in the LERV group (136min) in comparison to the two-staged group (102min;P=0.003). The mean operative time for ERCP was not significantly different between the LERV group (31min) and the two-staged group (33min; P= 0.83). No significant difference in PEP existed between either the LERV group (8%) or the two-stage group (14%; P=0.49). Similarly, LOS did not significantly differ between LERV group and the two-staged approach (5days and 6.2days, respectively; P=0.355). Despite the fact that total operative times were significantly increased in the LERV group with no significant decrease in PEP or LOS, we believe LERV does result in fewer unnecessary procedures and their associated complications.