Single-stage treatment with ERCP and laparoscopic cholecystectomy versus two-stage treatment with ERCP followed by...

Obstructive jaundice is one of the earliest symptoms of a hepatobiliary system disorder. The aim of the present study was to compare single stage endoscopic retrograde cholangiopancreatography (ERCP)/laparoscopic cholecystectomy (LC) and two-stage ERCP and LC with respect to the frequency of imaging, duration of anesthesia and the length of stay in our clinic.

Of the 350 patients undergoing ERCP between 01.01.2015 and 31.12.2016, 31 patients with single-stage ERCP and LC were assigned to Group A and 25 patients with two-stage ERCP followed by LC within 6-8 weeks were assigned to Group B. Eligibility criteria included ERCP duration, difficulty of the procedure, bile duct stones as demonstrated by imaging methods, no contraindications for LC and no suspected or known malignancy. The same surgeon performed ERCP and LC in both groups.

No cases of morbidity or mortality occurred in any groups. The average length of stay was 8.03 ± 4.97 days in Group A, which was significantly longer (9.92 ± 4.05 days) in Group B (p <0.026). However, the length of stay (in days) was calculated as the time from presentation to hospital until discharge and not the time elapsed after the procedure. Imaging methods were used 3.9 ± 3.07 times in Group A and significantly more frequently (5.92 ± 2.55 times) in Group B (p <0.001). Total duration of anesthesia was not statistically significantly different between the study groups (154.06 ± 53.76 min in Group A and 167.04 ± 75.17 min in Group B).

In conclusion, single-stage ERCP/LC is associated with shorter hospital stay and lower frequency of imaging and can be safely used in selected cases. No cases of pancreatitis or mortality occurred following the single-stage procedure. The single-stage procedure can be safely used in selected patients with obstructive jaundice.