Cholecystectomy or gallbladder in situ after endoscopic removal of bile duct stone

Background: Symptomatic cholelithiasis is a common gastrointestinal surgical entity having the complication of accumulation of gall stones. For patients with residual stones in the gallbladder after endoscopic stone removal, the subsequent management of the gallbladder has been subject to debate. Many authors have advocated a wait-and-see policy after ES for these patients because only an estimated 10% of them experience recurrent biliary symptoms. It is hypothesized that early planned LC after ES prevents recurrent biliary complications and reduces operative morbidity. Method: This randomized study included 100 patients with choledochocystolithiasis who underwent endoscopic retrograde cholangiapancreatography (ERCP). After ERCP patients were randomly assigned to laparoscopic cholecystectomy (LC) within six weeks of ERCP (Group I) or wait-and-see conservative management (W&S) with cholecystectomy performed only if indicated (Group II). The patients were followed for two years to record any biliary-related event. Results: In present study there was 34%of expectantly managed patients developed at least one recurrent biliary event after sphincterotomy during 2 years of follow up, compared with 4% who underwent laparoscopic cholecystectomy. In present study there were no cases underwent cholecystectomy on demand in group I (LC) but there was 18.0% in group II (W&S) underwent cholecystectomy on demand. Conclusion: Earlier laparoscopic cholecystectomy has been shown to improve outcomes after endoscopic sphincterotomy for choledochocystolithiasis. A wait-and-see policy after endoscopic sphincterotomy cannot be recommended as standard treatment.