Vol.:(0123456789) 1 3 Updates in Surgery https://doi.org/10.1007/s13304-019-00624-5 ORIGINAL ARTICLE Laparoscopic cholecystectomy after endoscopic treatment of choledocholithiasis: a retrospective comparative study Mario Trejo‑Ávila 1  · Danilo Solórzano‑Vicuña 1  · Ricardo García‑Corral 1  · Orlando Bada‑Yllán 1  · Adolfo Cuendis‑Velázquez 1  · Roberto Delano‑Alonso 1  · Jesus Herrera‑Esquivel 1  · Carlos Valenzuela‑Salazar 1 Received: 9 February 2018 / Accepted: 5 January 2019 © Italian Society of Surgery (SIC) 2019 Abstract Patients with combined choledocholithiasis and cholecystitis require treatment of both diseases. The aim of our study was to analyze perioperative results of next-day (< 24 h) vs. early (> 24 h) laparoscopic cholecystectomy (LC) after endoscopic clearance of common bile duct stones. We conducted a retrospective study of patients that underwent LC after endoscopic treatment of choledocholithiasis, with combined diagnoses of common bile duct stones (with or without acute cholangitis) and gallbladder stones (with acute or chronic cholecystitis). From January 2014 to May 2017, 87 patients underwent LC after endoscopic sphincterotomy: 40 patients within 24 h (NDLC) and 47 after 24 h (ELC). Regarding pre-ERCP diagnosis, 29 (72.5%) of patients in the NDLC group and 33 (70.2%) of patients in the ELC group had high-risk of choledocholithi- asis (p = 0.814), acute cholecystitis (32.5 vs. 25.5%, p = 0.474) and acute cholangitis (17.5 vs. 17%, p = 0.953). The median time from ERCP to LC was 23 h (IQR 22–23) in the NDLC group and 72 h (IQR 48–80) in the ELC group (p < 0.001). No statistically signifcant diferences were found in regard to operative time, estimated blood loss, overall morbidity and rate of conversion to open surgery. Patients in the NDLC group had a shorter total length of stay (2 vs. 4 days, p < 0.001). Laparoscopic cholecystectomy performed within the frst 24 h after endoscopic treatment of choledocholithiasis is safe and feasible, without increased postoperative morbidity and associated with reduction of the hospital length of stay. Keywords Laparoscopic cholecystectomy · ERCP · Choledocholithiasis · Endoscopic sphincterotomy Introduction There is still concern about the technical difculty of lapa- roscopic cholecystectomy (LC) following endoscopic retro- grade cholangiopancreatography (ERCP) in patients with choledocholithiasis and concomitant gallstone disease. Patients with combined choledocholithiasis (with or with- out cholangitis) and cholecystitis (acute or chronic) require treatment of both diseases [1]. The standard of care for com- mon bile ducts is endoscopic removal with sphincterotomy, and the treatment of choice for gallstone disease is laparo- scopic cholecystectomy [1–3]. The preferred initial approach to patients with choledo- cholithiasis is ERCP with endoscopic sphincterotomy (ES) [4]. If cholecystectomy is not performed, the incidence of further gallstone complications ranges from 11 to 47% [4, 5]. Although many options for treating concomitant chol- ecystocholedocholithiasis exist, the combination of ERCP and LC has become the standard of care [6]. In previous studies, conversion rate of laparoscopic chol- ecystectomy after ERCP was higher. Some researchers sug- gested that ERCP leads to an infammation around the gall- bladder, making the procedure more technical demanding [5, 7]. In addition, acute cholangitis leads to increased infam- mation around the portal structures, making the dissection of Calot’s triangle more difcult [4]. Another speculation is that after ES jejunal bacteria ascends and contaminate the bile, leading to infammation of the hepatoduodenal liga- ment [3]. Although many papers had investigated this subject, no clear evidence exists about the safest time interval between ERCP and LC. A definition of early LC varies among authors. The definition could be less than 24 h (“ultra rapid”), early (< 72 h) or less than 7 days [1, 3]. Although * Mario Trejo-Ávila mario.trejo.avila@gmail.com 1 Department of General and Endoscopic Surgery, Hospital General Dr. Manuel Gea González, Calzada de Tlalpan 4800, Mexico City 14090, Mexico