Synchronous Approach versus the Sequential Approach in Laparoscopic Cholecystectomy with Endoscopic Retrograde Cholangiopancreatography in Patients with Gallstones and Suspected Common Bile Duct Stones

• Main Authors: Chaloemphon Boonmee, Ueamporn Summart, Niramon Arayajarernwong, Wattana Pareesri, Taungprart Srigulawong, Somsak Boonharn, Siphon Naowarungsri, Wipapun Watayajinda
• Format: Article
• Language: English
• Published: JCDR Research and Publications Private Limited 2019-02-01
• Series: Journal of Clinical and Diagnostic Research
• Subjects: combined gallstone and cbd stones; cbd cannulation; synchronous approach lc with ercp
• Online Access: https://jcdr.net/articles/PDF/12574/38413_CE[Ra1]_F(AC)_PF1(SJ_SL)_PN(SL).pdf

Introduction: Common Bile Duct Stone (CBDS) is concomitant with Gallstone (GS) in 10-18% of patients. The most common procedure to treat CBDS with GS is with Endoscopic Retrograde Cholangiopancreatography (ERCP) and Laparoscopic Cholecystectomy (LC) which has commonly been done using a sequential approach. Currently, the one-step synchronous approach is commonly practiced. However, superiority of one protocol over another is yet to be established. Aim: To compare the operative outcomes between synchronous approach LC followed by ERCP in the same anaesthetic time (group I) and sequentially separated LC and ERCP (group II). Materials and Methods: A retrospective review of 66 patients from May 2015 to June 2017. The patients were diagnosed as having GS and were suspected of also having CBDS. They were divided into two groups: Group I had 41 patients and Group II had 25 patients. The baseline characteristics, operative findings and outcomes including success rate, operative time, postoperative complications and the Length Of Hospital Stay (LOS) of the two groups were compared. Results: There were no significant difference between the operative outcomes of the two groups regarding the CBDS cannulation rate (95.1% versus 100.0%) and clearance rate (89.7% versus 80.0%). The cannulation rate difference was -5.0% (95% CI=-11.5to1.7; p-value=0.26) and the clearance rate difference was 9.7% (95% CI=-8.6 to 28.1; p-value=0.27). Postoperative complications showed no statistically significant difference, however the LOS was significantly lower in group I with a mean difference of -4.0 days (95% CI=-5.4 to -2.6; p-value <0.001). Conclusion: The synchronous approach is as safe and effective as the sequential ERCP and LC. Moreover, it has advantages for patients such as a reduction in the number of procedures and requiring a shorter LOS.