Meta-analysis of the timing of laparoscopic cholecystectomy after endoscopic retrograde cholangiopancreatography in patients with cholecystolithiasis and choledocholithiasis

Abstract

Endoscopic retrograde cholangiopancreatography (ERCP) combined with laparoscopic cholecystectomy plays an important role in the treatment of cholecystolithiasis combined with choledocholithiasis; however, there is no unified standard for the interval of ERCP before laparoscopic cholecystectomy. We conducted a literature search, data extraction and meta-analysis on this topic. Twelve articles with 1142 patients were included, including 567 patients in the E-laparoscopic cholecystectomy group (laparoscopic cholecystectomy performed within 72 h after ERCP) and 575 patients in the D-laparoscopic cholecystectomy group (laparoscopic cholecystectomy performed 72 h after ERCP). The results showed that: compared with the D-laparoscopic cholecystectomy group, the duration of cholecystectomy was shorter in the E-laparoscopic cholecystectomy group [weighted mean difference (WMD) = −16.18, 95% confidence interval (CI) (−22.27 to −10.08), P < 0.00001], and the postoperative hospitalization was shorter [WMD = −1.24, 95% CI (−1.98 to −0.50), P < 0.0001]. There were fewer complications [odds ratio (OR) = 0.25, 95% CI (0.39–0.62), P < 0.0001], lower conversion rate [OR = 0.39, 95% CI (0.21–0.71), P = 0.002], lower high sensitivity C-reactive protein at 3 days after surgery [WMD = −8.76, 95% CI (−12.59 to −4.93), P < 0.00001], and fewer neutrophils in the ampulla of gallbladder specimen [WMD = −4.21, 95% CI (−4.55 to −3.88), P < 0.00001]. Therefore, in the treatment of cholecystolithiasis combined with choledocholithiasis by laparoscopic cholecystectomy within 72 h after ERCP, the degree of inflammation before and after surgery is less, the operation time and hospital stay are shortened, the postoperative complications and the conversion rate are reduced, which is a more appropriate time for surgery.