الفهرس 
REVIEW OF LITERATUREOnly 14 pages are availabe for public view
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Abstract
E
ndoscopic retrograde cholangiopancreatography (ERCP) is indicated for those patients who have clinical features and radiologic evidence of CBD stones.
Elective laparoscopic cholecystectomy (ELC) has an increased risk of complications after ERCP, with reports of longer operating times, increased bleeding, and higher rates of conversion to open surgery.
The aim of this study is to assess the complexity of LC post ERCP compared to elective LC without previous ERCP.
This study is a prospective cohort study of two groups of patients: patients who had undergone a previous ERCP for choledocolithiasis and patients with cholecystolithiasis who had no previous intervention prior to LC. This study carried out in Ain Shams university “El demerdash hospital” and Military hospitals”kobbry El kobba and El Maadi hospital” from November 1, 2019, to April 1, 2020.
The first group of 25 Patients without a previous ERCP (NPES), all cholecystectomies was done by an expert sugeon.
The second group of 25 patients actually underwent a cholecystectomy after ERCP, These patients were included in the PES group, the completion rate of ERCP was 100%,and all patients (100%) had CBD stones, and (60%) of these patients went to have a successful ductal clearance, the remaining patients (40%) underwent stenting, post procedural pancreatitis developed in (4%) of patients .
In our study, there is higher risk of difficulty in achieving critical view of safety in PES group (48%) due to severe adhesions more than NPES (8%) especially in cases with stent, as stent cause pericholecystic fibrosis.
In our study, there is a higher conversion rate of LC after ERCP compared with LC without previous ERCP, but this difference fails to reach statistical significance .
There is higher amount of collected drained fluid in the PES group (mean =80 ml) more than the NPES group (Mean =20 ml).
There is a shorter operative time in NPES group (P < 0.001) and this reflects the complexity of procedure in the LC post ERCP, we have interpreted significantly longer operating times as a surrogate marker of operative difficulty.
There is a higher rate of uncontrollable bleeding(12%) in the PES group more than NPES group(0%).
We concluded that the laparoscopic cholecystectomy is a safe operation, but laparoscopic cholecystectomy post ERCP is a challenge for any surgeon with higher complexity and longer time of operation, so it has to be done by an expert surgeon.