Lap Cholecystectomy with ERCP As a Combo Approach for the Management of Cholecysto -choledocholithiasis – A Retrospective Study

Dr Sreejoy Patnaik, MS. SHANTI MEMORIAL HOSPITAL PVT.LTD

BACKGROUND: In the management of Cholecysto-choledocholithiases, Laparoscopic Cholecystectomy and ERCP is today emerging as an alternative the treatment of choice. Other Modalities of treatment existing include Pre- & Post-operative ERCP,  Laparoscopic CBD Exploration trans-cystic approach, Laparoscopic Choledochotomy, Open CBD exploration.

MATERIAL AND METHODS: Retrospective study on 200 patients. Period of Study – 6 yrs. (2008- 2014). Criteria of the Study: All patients of Gallstones with CBD stones proven by USG.  CBD stone size < 1cm.  Gallstones with raised ALP / LFT.  Pre-operative Endoscopy were carried out in all the patients to exclude any upper GI pathology.  Patients with concomitant Pancreatitis were ruled out. MRCP was not taken into consideration due to its non-availability during this study.

RESULTS: This Combo procedure was found to be:  Cost effective, Time saving, Decreased risks of anesthesia, Over all patient satisfaction, Shortened hospital stay

CONCLUSIONS: Obstructive calculus biliary disease can effectively be treated by surgeons in a One Step fashion. By limiting the number of operative procedures and hospital days, patients can be safely and more efficiently treated using this method. We found a significant difference in total hospital charges.  Therefore the implementation of this combo approach (LC-ERCP) outweighs the two steps or sequential procedure & may be an alternative approach in the management of Obstructive calculus biliary disease.  For treatment of- cholecystocholedocholithiasis, synchronous LC combined with ERCP reduces incidence of complications, decreases length of hospital stay, simplifies the surgical procedure, and reduces the duration of operation.