One-stage versus sequential endoscopic retrograde cholangio- pancreatography and laparoscopic cholecystectomy in patients with symptomatic gallstones and suspected common bile duct stones

Introduction: The advantage of endoscopic and minimally invasive techniques has revolutionized the management of bile duct stones. Yet several controversies still surround the optimal means of investigation and treatment.
Aim: The aim of this study was to assess the feasibility of one-stage ERCP and LC and to compare the results with that of sequential ERCP and LC.
Patients and methods: Sixty patients complaining of calcular cholecystitis and suspected to have CBD stones were randomized into two groups by computer-generated random allocation software. Group I included 30 patients who underwent one-stage ERCP and LC. Group II included 30 patients who were treated with sequential ERCP and LC.
Results: Success rate in Group I was 26/28 (93%) while in Group II it was 24/27(89%). Failure rate in Group I was in 2/28(7%) while the failure rate in Group II was 3/27 (11%). The mean operative time in Group I was 136±11.56 min while it was 145±12.89 min in Group II. One patient in Group I developed mild attack of pancreatitis while in Group II, 2 patients developed pancreatitis, the first one on the second day post ERCP and the other patient developed an attack of pancreatitis during the interval period waiting for LC. No significant difference between both groups as regards successes and failure rates, operative time and post operative complications. The mean hospital stay in group I was 1.8±0.23 days while in group II it was 4.7±0.85 days and this was a statistically significant difference between both groups.
Conclusion: Single stage ERCP and LC can be safely performed with no technical difficulties. The advantages of the one stage procedure include one-stage treatment of cholelithiasis and choledocholithiasis, avoidance of another anesthetic session in short period and shorter hospital stay