Journal of postgraduate medicine · 2025
Laparoscopic cholecystectomy without biliary stenting post-ERCP clearance: Prospective outcomes from a tertiary care center.
СтатьяНаблюдательное исследованиеНазвание и аннотация: Перевод в очереди
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Prajapati R, Shetty S, Chaudhary A, Khajanchi M, Bhoir R
Аннотация
INTRODUCTION: Common bile duct (CBD) stones are present in approximately 5-18% of patients undergoing cholecystectomy for gallstones. Nearly half of them suffer from complications of choledocholithiasis. Such cases are managed by endoscopic retrograde cholangio-pancreatography (ERCP) with stone clearance followed by laparoscopic cholecystectomy (LC). Prophylactic CBD stenting post-ERCP stone clearance is practiced in some centers to prevent stone reimpaction, though its necessity remains debated due to potential complications such as adhesions and technical difficulty during subsequent surgery.
MATERIALS AND METHODS: This prospective observational study included 84 patients aged ≥18 years who underwent LC within seven days of successful ERCP with complete CBD clearance, without stenting. Intraoperative parameters and difficulties, postoperative complications, and hospital stay were recorded. Patients were followed up to 14 days postprocedure.
RESULTS: Among 84 patients (61.9% female; mean age 39.8 ± 4.5 years), 79.8% achieved single-session CBD clearance. Intraoperative adhesions were seen in 40.5% of cases. Bile spillage occurred in 17.9%; 15.5% experienced blood loss >100 ml. Conversion to open cholecystectomy was required in 11.9% of patients. The average hospital stay was 3.48 ± 1.65 days. No readmissions or recurrent CBD stones were noted at follow-up.
CONCLUSIONS: Omitting prophylactic CBD stenting after ERCP does not increase intraoperative or postoperative complications. Early LC without stenting is a safe, effective, and resource-optimized strategy, suggesting ease of surgery without any stent-in-situ and early discharge as well as the added benefit of no need of stent removal later.
MATERIALS AND METHODS: This prospective observational study included 84 patients aged ≥18 years who underwent LC within seven days of successful ERCP with complete CBD clearance, without stenting. Intraoperative parameters and difficulties, postoperative complications, and hospital stay were recorded. Patients were followed up to 14 days postprocedure.
RESULTS: Among 84 patients (61.9% female; mean age 39.8 ± 4.5 years), 79.8% achieved single-session CBD clearance. Intraoperative adhesions were seen in 40.5% of cases. Bile spillage occurred in 17.9%; 15.5% experienced blood loss >100 ml. Conversion to open cholecystectomy was required in 11.9% of patients. The average hospital stay was 3.48 ± 1.65 days. No readmissions or recurrent CBD stones were noted at follow-up.
CONCLUSIONS: Omitting prophylactic CBD stenting after ERCP does not increase intraoperative or postoperative complications. Early LC without stenting is a safe, effective, and resource-optimized strategy, suggesting ease of surgery without any stent-in-situ and early discharge as well as the added benefit of no need of stent removal later.