Does Preoperative ERCP Influence Postoperative Outcomes of Cholecystectomy?

Purpose: “Gold standard" treatment for symptomatic cholelithiasis is laparoscopic cholecystectomy. In patients with choledocholithiasis, ERCP before cholecystectomy is the most frequent therapeutical algorithm. Preoperative ERCP has been associated with greater surgical difficulty during cholecystectomy. Our objective is to evaluate whether preoperative ERCP influences the surgical difficulty and implies an increase in postoperative complications, hospital stay, readmission rate and percentage of "textbook outcome" (TO). Methods: Retrospective observational study. Inclusion criteria: cholecystectomies between 1/1/2016 and 31/12/2018. Exclusion criteria: cholecystectomy associated with another unrelated procedure or oncological patient. We recorded the perioperative characteristics and variables, including a difficult cholecystectomy classification. Subsequently, we carried out an analytical study of retrospective cohorts, analysing perioperative characteristics, morbimortality, readmissions and TO, according to ERCP was performed or not. Results: We analysed 535 patients. After exclusion criteria, 475 patients were included. 422 patients belonged to ERCP-NO Group, while ERCP was performed in 53 patients (median time ERCP-surgery 9 weeks). Overall data: median age 63yo, 56.4% women, 75.2% ASAII, less laparoscopic surgery, more conversions and open surgery, more difficult cholecystectomy and more patients with hospital stay>3d (p75). There were not more major complications CD>II, mortality, readmissions or less TO. Postoperative biliary complications in ERCP Group were 13% lower. Conclusion: ERCP+cholecystectomy is associated with greater surgical difficulty, causing an increase in open surgery, conversion and hospital stay rates. TO rates, postoperative complications, mortality and readmissions are not statistically different in both groups.