Early or delayed laparoscopic cholecystectomy after endoscopic cholangiopancreatography and papillotomy- does it make a difference?

Background Endoscopic retrograde cholangiopancreatography with endoscopic papillotomy (ERCP/EPT) followed by a cholecystectomy is a standard treatment of common biliary duct stones. It is unclear, however, what is the optimal time interval between ERCP/EPT and cholecystectomy. The primary aim of our study was to evaluate our current practice where patients are mostly operated one to three months after ERCP/EPT. The secondary aim was to determine the optimal timing for the cholecystectomy after ERCP/EPT.Methods A retrospective analysis of 117 patients who underwent a preoperative ERCP/EPT followed by a cholecystectomy was performed. Associations between demographic characteristics, type and duration of operation, conversion rate, postoperative complications and interval time were tested using multiple linear regression. The optimal interval was studied by drawing receiver operating curve (ROC) and studying the area under curve (AUC).Results The time interval between cholecystectomy and ERCP/EPT was not associated with the number of conversions to open surgery, duration of the operation or postoperative complications. There was no statistically significant association between any independent variable and time interval. No threshold interval could be found that would discriminate whether a patient had either operation conversion or complications or not.Conclusion No statistically significant associations between the timing of cholecystectomy after ERCP/EPT and the rate of conversions, complications or operation duration are seen in the group. Our current practice is safe, as the time interval in our study does not affect the rate of conversions, postoperative complications or operation duration. Based on the results of our study, no recommendations regarding the optimal time for the surgery can be given. Larger prospective randomized trials are needed.