Early Versus Late Cholecystectomy After Clearance of Common Bile Duct Stones
Early Versus Late Cholecystectomy After Clearance of Common Bile Duct Stones
Approximately 10-15% of all patients with gallstones have coexisting common bile duct (CBD)
 stones. However CBD stones can also be formed in the absence of gallbladder stones. The
 current standard of treatment for calcular obstructive jaundice is endoscopic removal of the
 stones. Endoscopic sphincterotomy (ES) is widely accepted as the treatment of choice for
 patients with CBDS. Stone extraction is successful in up to 97% of patients The time interval
 between ERCP and laparoscopic cholecystectomy (LC) is a matter of debate that may vary from
 days to months. Some retrospective and other prospective studies have investigated this issue
 without sharp clue or definite conclusion This study planned to compare early LC (within
 admission) versus late LC (after 1 month) after ERCP as regard technical difficulties and
 surgical outcomes.
The aim is comparing early versus delayed laparoscopic cholecystectomy after endoscopic
 retrograde cholangiopancreatography in patients with gall bladder stones and calcular
 obstructive jaundice as regards operative difficulties, conversion rate, signs of
 inflammation, degree of adhesions, blood loss, postoperative morbidity, and hospital stay.
 Moreover, bacterial examination of bile and culture sensitivity test for assessment of
 bacterial colonization and relate the degree of colonization to timing of laparoscopic
 cholecystectomy after endoscopic retrograde cholangiopancreatography, to decide upon the
 optimal timing for the surgery.

 The study population will be divided into 2 groups; group (A) will be managed by early
 laparoscopic cholecystectomy (LC) within 3 days after ERCP and group (B) will be managed by
 late LC one month after ERCP.
Inclusion Criteria:

 -  Patients with CBD stone and treated by ERCP

 Exclusion Criteria:

 -  Patient unfit for surgery,

 -  Pregnant patients,

 -  Patients with severe malnutrition,

 -  Patients with liver cirrhosis,

 -  Patients in whom endoscopic management of CBD stones failed

 -  Patients who experienced pancreatitis or perforation as a complication of the
 endoscopic management of CBD stones

 -  Patients who underwent previous upper abdominal surgeries

 -  Mentally retarded patients.