Timing of cholecystectomy after endoscopic sphincterotomy for common bile duct stones

Abstract

Background According to the literature, the conversion rate for laparoscopic cholecystectomy (LC) after endoscopic sphincterotomy (ES) for cholecystodocholithiasis reaches 20%, at least when LC is performed 6 to 8 weeks afterward. It is hypothesized that early planned LC after ES prevents recurrent biliary complications and reduces operative morbidity and hospital stay. Methods All consecutive patients who underwent LC after ES between 2001 and 2004 were retrospectively evaluated. Recurrent biliary complications during the waiting time for LC, conversion rate, postoperative complications, and hospital stay were documented. Results This study analyzed 167 consecutive patients (59 men) with a median age of 54 years. The median interval between ES and LC was 7 weeks (range, 1-49 weeks). During the waiting time for LC, 33 patients (20%) had recurrent biliary complications including cholecystitis (n = 18, 11%), recurrent choledocholithiasis (n = 9, 5%), cholangitis (n = 4, 2%), and biliary pancreatitis (n = 2, 1%). Of these 33 patients, 15 underwent a second endoscopic retrograde cholangiography (ERC). The median time between ES and the development of recurrent complications was 22 days (range, 3-225 days). Most of the biliary complications (76%) occurred more than 1 week after ES. Conversion to open cholecystectomy occurred for 7 of 33 patients with recurrent complications during the waiting period, compared with 13 of 134 patients with an uncomplicated waiting period (p = 0.14). This concurred with doubled postoperative morbidity (24% vs 11%; p = 0.09) and a longer hospital stay (median, 4 vs 2 days; p \ 0.001). Conclusion In this retrospective analysis, 20% of all patients had recurrent biliary complications during the waiting period for cholecystectomy after ES. These recurrent complications were associated with a significantly longer hospital stay. Cholecystectomy within 1 week after ES may prevent recurrent biliary complications in the majority of cases and reduce the postoperative hospital stay.Keywords Biliary complications Á Cholecystectomy Á Common bile duct Á Conversion rate Á Endoscopic sphincterotomyOf the patients presenting with cholecystolithiasis, 4% to 15% have concomitant common bile duct (CBD) stones [1][2][3]. The current standard of treatment for symptomatic

Timing of elective laparoscopic cholecystectomy after endoscopic retrograde cholangiopancreaticography with sphincterotomy: a prospective observational study of 308 patients

“…If disease progression is the main reason for higher conversion rates in subsequent LC, then longer intervals would be expected to be associated with higher conversion rates. However, of the studies that have specifically investigated time intervals between the two procedures [6,8,9], one study found a shorter interval to be associated with fewer conversions to open cholecystectomy [8], while the other studies found no association. We also found that post-ERCP time interval and conversion rates were not associated with each other.…”

“…The time interval between ERCP and LC has been investigated in retrospective studies [6,8,9], with one study finding that a shorter interval (<2 weeks) was associated with significantly fewer conversion to open cholecystectomy [8]. The aim of the present study was to investigate prospectively, in patients undergoing ERCP with sphincterotomy followed by LC, whether the time interval between the two procedures can affect the course of LC in terms of conversion rate or complications.…”

Preoperative versus intraoperative endoscopic sphincterotomy for management of common bile duct stones

“…These recurrent complications were associated with a significantly longer hospital stay. Cholecystectomy within 1 week after ES, as followed in this study, may prevent recurrent biliary complications in the majority of cases and reduce the postoperative hospital stay [44].…”

Optimal timing of laparoscopic cholecystectomy after endoscopic retrograde cholangiopancreatography

“…5,6 Concomitantly, recurrent biliary complications in the majority of cases could be prevented minimised the postoperative hospital stay. 7 Earlier laparoscopic cholecystectomy was reported to improve outcomes after endoscopic sphincterotomy for choledochocystolithiasis. [8][9][10] It is cost effective in developing countries.…”