IS ONE STAGE LAPAROSCOPIC CHOLECYSTECTOMY AND COMMON BILE DUCT EXPLORATION BETTER THAN 2 STAGES ERCP FOLLOWED BY LAPAROSCOPIC CHOLECYSTECTOMY?

BACK GROUND  10-15% patients of cholelithiasis have concomitant choledocholithiasis. Laparoscopic common bile duct exploration and laparoscopic cholecystectomy (LCBDE-LC) offers one stage treatment for cholelithiasis and choledocholithiasis in contrast to ERCP and laparoscopic cholecystectomy (ERCP-LC). The aim of this study was to compare the effectiveness of both approaches in the treatment of cholelithiasis and choledocholithiasis. MATERIAL AND METHODS This prospective comparative study was conducted in two hospitals, Bahawal Victoria Hospital, Bahawalpur, where LCBDE-LC was performed, and Shahida Islam Hospital, Lodhran, where ERCP-LC was performed. Fifty patients with gallstones and common bile duct stones were included in the study, of whom 25 patients underwent LCBDE-LC in BVH (group A) and Twenty-five patients underwent ERCP-LC (Group B) in SIH. Data were collected in tabular form and analyzed using SPSS version 27. Results were considered significant when p value ≤ 0.05 using the chi-square test. RESULTS: Cholelithiasis and choledocholithiasis were more common in obese and overweight females. LCBDE-LC group had shorter hospital stay, shorter operating time, high CBD clearance rate and low complication rate as compared to ERCPC-LC group. There was no case of recurrent stone in either group.  CONCLUSION: There is no significant difference in morbidity between LCBDE-LC and ERCP-LC  LCBDE-LC has a shorter hospital stay, shorter operating time, higher clearance rate, and lower incidence of pancreatitis and cholangitis. If the CBD is dilated (>7 mm), LCBDE-LC can be used as the first treatment option and if the CBD is mildly dilated (<7 mm) or normal in size, ERCP-LC is the treatment of choice. KEYWORDS: Choledocholithiasis, Laparoscopic Common Bile Duct Exploration , Endoscopic Retrograde Cholangiopancreatography , Laparoscopic Cholecystectomy (LC)