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Büyükkasap Ç, Algan D, Balakji N, Metindoğan O, Karataş A, Yavuz A, Göbüt H, Dikmen K, Kekilli M, Bostancı H. Early Cholecystectomy after Endoscopic Retrograde Cholangiopancreatography Is Feasible and Safe. Healthcare (Basel) 2024; 12:1407. [PMID: 39057550 PMCID: PMC11275435 DOI: 10.3390/healthcare12141407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Revised: 06/27/2024] [Accepted: 07/12/2024] [Indexed: 07/28/2024] Open
Abstract
Laparoscopic cholecystectomy (LC) following endoscopic retrograde cholangiopancreatography (ERCP) is the preferred treatment for cholelithiasis with common bile duct stones. However, the optimal timing of LC after ERCP remains controversial. This study aimed to identify the ideal time interval between ERCP and LC. Data from patients who underwent LC after ERCP between November 2016 and August 2022 were retrieved from the electronic medical information system. The patients were categorized into early cholecystectomy (within 72 h of ERCP) and delayed cholecystectomy (after 72 h). The impact of the time interval between ERCP and LC on perioperative outcomes was analyzed. A total of 197 patients were included in the study, with 45 undergoing early cholecystectomy and 152 undergoing delayed cholecystectomy. No significant differences in the preoperative characteristics or operative morbidity were observed between the groups (p = 0.286). However, a significant correlation was found between the time interval from ERCP to LC and the total length of stay (r = -350, p < 0.001). The findings suggest that early cholecystectomy after ERCP is feasible and safe, and performing LC within the first 72 h does not adversely affect postoperative outcomes.
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Affiliation(s)
- Çağrı Büyükkasap
- Department of General Surgery, Gazi University Faculty of Medicine, 06500 Ankara, Turkey; (O.M.); (A.Y.); (H.G.); (K.D.); (H.B.)
| | - Deniz Algan
- Gazi University Faculty of Medicine, 06500 Ankara, Turkey; (D.A.); (N.B.)
| | - Nigar Balakji
- Gazi University Faculty of Medicine, 06500 Ankara, Turkey; (D.A.); (N.B.)
| | - Onur Metindoğan
- Department of General Surgery, Gazi University Faculty of Medicine, 06500 Ankara, Turkey; (O.M.); (A.Y.); (H.G.); (K.D.); (H.B.)
| | - Ali Karataş
- Department of Gastroenterology, Gazi University Faculty of Medicine, 06500 Ankara, Turkey; (A.K.); (M.K.)
| | - Aydın Yavuz
- Department of General Surgery, Gazi University Faculty of Medicine, 06500 Ankara, Turkey; (O.M.); (A.Y.); (H.G.); (K.D.); (H.B.)
| | - Hüseyin Göbüt
- Department of General Surgery, Gazi University Faculty of Medicine, 06500 Ankara, Turkey; (O.M.); (A.Y.); (H.G.); (K.D.); (H.B.)
| | - Kürşat Dikmen
- Department of General Surgery, Gazi University Faculty of Medicine, 06500 Ankara, Turkey; (O.M.); (A.Y.); (H.G.); (K.D.); (H.B.)
| | - Murat Kekilli
- Department of Gastroenterology, Gazi University Faculty of Medicine, 06500 Ankara, Turkey; (A.K.); (M.K.)
| | - Hasan Bostancı
- Department of General Surgery, Gazi University Faculty of Medicine, 06500 Ankara, Turkey; (O.M.); (A.Y.); (H.G.); (K.D.); (H.B.)
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Sohail A, Shehadah A, Chaudhary A, Naseem K, Iqbal A, Khan A, Singh S. Impact of index admission cholecystectomy vs interval cholecystectomy on readmission rate in acute cholangitis: National Readmission Database survey. World J Gastrointest Endosc 2024; 16:350-360. [PMID: 38946855 PMCID: PMC11212518 DOI: 10.4253/wjge.v16.i6.350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Revised: 04/25/2024] [Accepted: 05/10/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND Elective cholecystectomy (CCY) is recommended for patients with gallstone-related acute cholangitis (AC) following endoscopic decompression to prevent recurrent biliary events. However, the optimal timing and implications of CCY remain unclear. AIM To examine the impact of same-admission CCY compared to interval CCY on patients with gallstone-related AC using the National Readmission Database (NRD). METHODS We queried the NRD to identify all gallstone-related AC hospitalizations in adult patients with and without the same admission CCY between 2016 and 2020. Our primary outcome was all-cause 30-d readmission rates, and secondary outcomes included in-hospital mortality, length of stay (LOS), and hospitalization cost. RESULTS Among the 124964 gallstone-related AC hospitalizations, only 14.67% underwent the same admission CCY. The all-cause 30-d readmissions in the same admission CCY group were almost half that of the non-CCY group (5.56% vs 11.50%). Patients in the same admission CCY group had a longer mean LOS and higher hospitalization costs attributable to surgery. Although the most common reason for readmission was sepsis in both groups, the second most common reason was AC in the interval CCY group. CONCLUSION Our study suggests that patients with gallstone-related AC who do not undergo the same admission CCY have twice the risk of readmission compared to those who undergo CCY during the same admission. These readmissions can potentially be prevented by performing same-admission CCY in appropriate patients, which may reduce subsequent hospitalization costs secondary to readmissions.
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Affiliation(s)
- Abdullah Sohail
- Department of Internal Medicine, University of Iowa Roy J and Lucille A Carver College of Medicine, Iowa, IA 52242, United States
| | - Ahmed Shehadah
- Department of Internal Medicine, Rochester General Hospital, Rochester, NY 14621, United States
| | - Ammad Chaudhary
- Department of Internal Medicine, Henry Ford Hospital, Detroit, MI 48202, United States
| | - Khadija Naseem
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH 44195-0001, United States
| | - Amna Iqbal
- Department of Internal Medicine, University of Toledo, Toledo, OH 43606, United States
| | - Ahmad Khan
- Department of Gastroenterology and Hepatology, Case Western Reserve University Hospital, Cleveland, OH 44106, United States
| | - Shailendra Singh
- Division of Gastroenterology and Hepatology, West Virginia University School of Medicine, Morgantown, WV 26505, United States
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Emre B, Mehlika BK, Metehan A, Taylan UE, Sezgin Y. The effect of previous endoscopic retrograde cholangiopancreatography on subsequent laparoscopic cholecystectomy: The retrospective analysis of 1500 patients. J Minim Access Surg 2024:01413045-990000000-00027. [PMID: 38214285 DOI: 10.4103/jmas.jmas_217_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 10/03/2023] [Indexed: 01/13/2024] Open
Abstract
INTRODUCTION Laparoscopic cholecystectomy (LC) is the gold standard for patients with acute cholecystitis at early period. However, 15%-20% of patients with acute cholecystitis develop obstructive jaundice, cholangitis and bile duct stones ultimately requiring endoscopic retrograde cholangiopancreatography (ERCP). In such cases, a two-session approach is usually recommended, first ERCP followed by LC thereafter. However, the effect of prior ERCP on the difficulty of subsequent LC is unknown. Hence, the aim of the present study is to determine the effects of previous ERCP on the results of LC. PATIENTS AND METHODS In this study, the files of 1500 patients who underwent LC were reviewed retrospectively. The patients were divided into three groups (500 patients for each group). The patients undergoing LC for asymptomatic cholelithiasis were assigned to the L-e group. The patients who underwent LC for acute cholecystitis were assigned to the L-c group. The patients with acute cholecystitis who underwent ERCP first and then LC were assigned to the L-ercp group. The rates of conversion to open cholecystectomy, operation times, complication rates and hospital stays of the three groups were compared. RESULTS The results of LC performed after ERCP are similar to the results of LC for cholecystitis without ERCP in terms of operation time, hospital stay, conversion and complications. CONCLUSIONS Previous ERCP does not affect the safety and effectiveness of early LC in patients with acute cholecystitis.
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Affiliation(s)
- Balli Emre
- Department of General Surgery, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - Bilgi Kirmaci Mehlika
- Department of General Surgery, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - Aydin Metehan
- Department of General Surgery, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - Ugurlu Esat Taylan
- Department of General Surgery, Mehmet Akıf Inan Educatıon and Research Hospıtal, Şanlıurfa, Turkey
| | - Yilmaz Sezgin
- Department of General Surgery, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
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Bergeron E, Doyon T, Manière T, Désilets É. Delay for cholecystectomy after common bile duct clearance with ERCP is just running after recurrent biliary event. Surg Endosc 2023; 37:9546-9555. [PMID: 37726412 PMCID: PMC10709473 DOI: 10.1007/s00464-023-10423-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 08/31/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND Gallstone disease will affect 15% of the adult population with concomitant common bile duct stone (CBDS) occurring in up to 30%. Endoscopic retrograde cholangiopancreatography (ERCP) is the mainstay of management for removal of CBDS, as cholecystectomy for the prevention of recurrent biliary event (RBE). RBE occurs in up to 47% if cholecystectomy is not done. The goal of this study was to evaluate the timing of occurrence of RBE after common bile duct clearance with ERCP and associated outcomes. METHODS The records of all patients who underwent ERCP for gallstone disease followed by cholecystectomy, in a single center from 2010 to 2022, were reviewed. All RBE were identified. Actuarial incidence of RBE was built. Patients with and without RBE were compared. RESULTS The study population is composed of 529 patients. Mean age was 58.0 (18-95). There were 221 RBE in 151 patients (28.5%), 39/151 (25.8%) having more than one episode. The most frequent RBE was acute cholecystitis (n = 104) followed by recurrent CBDS (n = 95). Median time for first RBE was 34 days. Actuarial incidence of RBE started from 2.5% at 7 days to reach 53.3% at 1 year. Incidence-rate of RBE was 2.9 per 100 person-months. Patients with RBE had significant longer hospitalisation time (11.7 vs 6.4 days; P < 0.0001), longer operative time (66 vs 48 min; P < 0.0001), longer postoperative stay (2.9 vs 0.9 days; P < 0.0001), higher open surgery rate (7.9% vs 1.3%; P < 0.0001), and more complicated pathology (23.8% vs 5.8%; P < 0.0001) and cholecystitis (64.2% vs 25.9%; P < 0.0001) as final diagnoses. CONCLUSIONS RBE occurred in 28.5% of the subjects at a median time of 34 days, with an incidence of 2.5% as early as 1 week. Cholecystectomy should be done preferably within 7 days after common bile duct clearance in order to prevent RBE and adverse outcomes.
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Affiliation(s)
- Eric Bergeron
- Department of Surgery, Charles-LeMoyne Hospital, 3120, Boulevard Taschereau, Greenfield Park, QC, J4V 2H1, Canada.
| | - Théo Doyon
- Department of Gastroenterology, Charles-LeMoyne Hospital, Greenfield Park, QC, Canada
| | - Thibaut Manière
- Department of Gastroenterology, Charles-LeMoyne Hospital, Greenfield Park, QC, Canada
| | - Étienne Désilets
- Department of Gastroenterology, Charles-LeMoyne Hospital, Greenfield Park, QC, Canada
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Tian WM, Chang D, Pressley M, Muhammed M, Fong P, Webster W, Herbert G, Gallagher S, Watters CR, Yoo JS, Zani S, Agarwal S, Allen PJ, Seymour KA. Development of a prospective biliary dashboard to compare performance and surgical cost. Surg Endosc 2023; 37:8829-8840. [PMID: 37626234 DOI: 10.1007/s00464-023-10376-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 07/30/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND Transparency around surgeon level data may align healthcare delivery with quality care for patients. Biliary surgery includes numerous procedures performed by both general surgeons and subspecialists alike. Cholecystectomy is a common surgical procedure and an optimal cohort to measure quality outcomes within a healthcare system. METHODS Data were collected for 5084 biliary operations performed by 68 surgeons in 11 surgical divisions in a health system including a tertiary academic hospital, two regional community hospitals, and two ambulatory surgery centers. A privacy protected dashboard was developed to compare surgeon performance and cost between July 2018 and June 2022. A sample cohort of patients ≥ 18 years who underwent cholecystectomy were compared by operative time, cost, and 30-day outcomes. RESULTS Over 4 years, 4568 cholecystectomy procedures were performed by 57 surgeons. Operations were done by 57 surgeons in four divisions and included 3846 (84.2%) laparoscopic cholecystectomies, 601 (13.2%) laparoscopic cholecystectomies with cholangiogram, and 121 (2.6%) open cholecystectomies. Patients were admitted from the emergency room in 2179 (47.7%) cases while 2389 (52.3%) cases were performed in the ambulatory setting. Individual surgeons were compared to peers for volume, intraoperative data, cost, and outcomes. Cost was lowest at ambulatory surgery centers, yet only 4.2% of elective procedures were performed at these facilities. Prepackaged kits with indocyanine green were more expensive than cholangiograms that used iodinated contrast. The rate of emergency department visits was lowest when cases were performed at ambulatory surgery centers. CONCLUSION Data generated from clinical dashboards can inform surgeons as to how they compare to peers regarding quality metrics such as cost, time, and complications. In turn, this may guide strategies to standardize care, optimize efficiency, provide cost savings, and improve outcomes for cholecystectomy procedures. Future application of clinical dashboards can assist surgeons and administrators to define value-based care.
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Affiliation(s)
| | - Doreen Chang
- Department of Surgery, Duke University, Durham, NC, USA
| | - Melissa Pressley
- Performance Services, Duke University Health System, Durham, NC, USA
| | - Makala Muhammed
- Performance Services, Duke University Health System, Durham, NC, USA
| | - Philip Fong
- Department of Surgery, Duke University, Durham, NC, USA
| | - Wendy Webster
- Department of Surgery, Duke University, Durham, NC, USA
| | - Garth Herbert
- Department of Surgery, Duke University, Durham, NC, USA
| | | | | | - Jin S Yoo
- Department of Surgery, Duke University, Durham, NC, USA
| | - Sabino Zani
- Department of Surgery, Duke University, Durham, NC, USA
| | | | - Peter J Allen
- Department of Surgery, Duke University, Durham, NC, USA
| | - Keri A Seymour
- Department of Surgery, Duke University, Durham, NC, USA.
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Li Z, Xu D, Yu H, Jiang H, Jin J. Meta-analysis of the timing of laparoscopic cholecystectomy after endoscopic retrograde cholangiopancreatography in patients with cholecystolithiasis and choledocholithiasis. Eur J Gastroenterol Hepatol 2023; 35:619-628. [PMID: 37115972 DOI: 10.1097/meg.0000000000002553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
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.
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Affiliation(s)
- Zhan Li
- Department of Gastrointestinal Surgery, the Fourth Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
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Sewefy AM, Elsageer EM, Kayed T, Mohammed MM, Taha Zaazou MM, Hamza HM. Nasobiliary guided laparoscopic cholecystectomy following endoscopic retrograde cholangiopancreatography, randomized controlled trial. Surgeon 2022:S1479-666X(22)00101-9. [PMID: 35953433 DOI: 10.1016/j.surge.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 06/18/2022] [Accepted: 06/28/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Endoscopic retrograde cholangiopancreatography (ERCP) followed by laparoscopic cholecystectomy (LC) is the most common management of gallstones combined with common bile duct (CBD) stones. This study aims to evaluate the impact of routine insertion of nasobiliary catheter during ERCP in cases of difficult LC. PATIENTS & METHODS From total 110 patients who underwent ERCP followed by LC in the period from April 2019 to April 2020, nasobiliary (NB) catheter was inserted during ERCP in 55 patients after CBD clearance (NB group). In the other 55 patients, only CBD clearance was done (Control group). In the NB group, dynamic trans-nasobiliary intraoperative cholangiography (TN-IOC) was done during dissection of Calot's triangle. At the end of the procedure, trans-nasobiliay methylene blue (MB) test was done to detect any missed biliary injury. The primary outcome to be analyzed was the incidence and severity of bile duct injury (BDI), secondary outcomes were the operative time, conversion to open surgery, and hospital stay. RESULTS Of the 110 patients, 57 patients (51.8%) were males and 53 (48.2%) were females. Median age was 55 years. One case of biliary leak was reported in the NB group (1.8%), while 2 cases (3.6%) were reported in the Control group. The average operative time in the NB group was 115 min versus 128 min in the Control group (P value < 0.001). No cases were converted to open cholecystectomy in the NB group (0%) with 5 cases (9.1%) converted to open in the Control group. The average postoperative hospital stay was 2 ± 0.1 days in the NB group versus 3.6 ± 5.3 days in the Control group (P value = 0.037). CONCLUSION Routine insertion of nasobiliary tube during ERCP, in patients with combined gallbladder and CBD stones, is a simple, safe and dynamic method for IOC. This maneuver does not statistically decrease the incidence of BDI but can diagnose, minimize and treat BDI with shorter operative time and hospital stay.
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Affiliation(s)
- Alaa M Sewefy
- Department of General Surgery, Faculty of Medicine, Minia University, Egypt
| | - Emad M Elsageer
- Department of General Surgery, Faculty of Medicine, Minia University, Egypt
| | - Taha Kayed
- Department of General Surgery, Faculty of Medicine, Minia University, Egypt
| | | | - Mohamed M Taha Zaazou
- Department of General Surgery, Faculty of Medicine, Misr University for Science and Technology, Egypt
| | - Hosam M Hamza
- Department of General Surgery, Faculty of Medicine, Minia University, Egypt.
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Strohaeker J, Sabrow J, Yurttas C, Königsrainer A, Ladurner R, Hoenes F. Management of Symptomatic Gallstone Disease during COVID-19 Lockdown in a High-Resource Setting: Is There a Need for Treatment Alterations? Visc Med 2022; 38:265-271. [PMID: 36160825 PMCID: PMC9421663 DOI: 10.1159/000519789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 09/17/2021] [Indexed: 08/03/2023] Open
Abstract
Introduction Cholecystectomy (CCE) is the treatment of choice of symptomatic gallstones. Due to the SARS-CoV-2 pandemic, operating room (OR) capacities have been reduced. The goal of this study was to evaluate the duration of symptoms of patients presenting with gallstone disease during a lockdown, the surgical management, and the severity grade of their disease. Materials and Methods A cohort study of 353 CCEs performed at a university hospital over two 10-week periods during 2 pandemic lockdowns in Germany compared to corresponding periods in 2018 and 2019. Results During the lockdowns, 101 CCEs were performed compared to 252 in the prior years. The number of elective CCEs was reduced to save OR capacities (p < 0.001), and the most common indication for CCE was acute cholecystitis. The median time to CCE after symptom onset was 3 days in both groups for acute cholecystitis. The severity of cholecystitis was comparable (p = 0.760). The time to CCE after choledocholithiasis was shorter during the lockdowns (median of 4 days vs. 9 days; p = 0.006). Conclusions The incidence and severity of acute cholecystitis during the lockdowns were comparable to the prior years. Acute care surgery was provided at the expense of elective procedures, and there was no need for treatment alterations.
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Affiliation(s)
- Jens Strohaeker
- Department of General, Visceral and Transplantation Surgery, University Hospital of Tuebingen, Tuebingen, Germany
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Liu H, Pan W, Yan G, Li Z. A retrospective cohort study on the optimal interval between endoscopic retrograde cholangiopancreatography and laparoscopic cholecystectomy. Medicine (Baltimore) 2022; 101:e29728. [PMID: 35801791 PMCID: PMC9259109 DOI: 10.1097/md.0000000000029728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Endoscopic retrograde cholangiopancreatography (ERCP) and laparoscopic cholecystectomy (LC) are the most important procedures for patients with choledocholithiasis and gallstones. Many studies recommend early LC after ERCP; however, there is still no consensus on the optimal interval between the two. The purpose of this study was to investigate the appropriate timing of LC after ERCP in patients with choledocholithiasis and cholecystolithiasis. We retrospectively reviewed all ERCPs in our institution from November 2014 to August 2021. All eligible 261 patients were divided into ERCP-LC1 (≤3 days), ERCP-LC2 (3-7 days), and ERCP-LC3 (>7 days). We also reviewed 90 patients with elective LC as the LC group. Procedures, treatment outcomes, and postoperative adverse events were evaluated. In a total of 1642 ERCPs, 261 eligible patients were divided into ERCP-LC1 (n = 102), ERCP-LC2 (n = 113), and ERCP-LC3 (n = 46). The ERCP-LC groups had no difference in operation time, postoperative adverse events, and open conversion rate with the LC group, but the total hospital stay and hospital stay after LC were longer than the LC group. There were no differences between the ERCP-LC groups in operation time, hospital stay after LC, open conversion rate, postoperative adverse events, and efficacy. However, LC within 7 days and even 3 days after ERCP had significant advantages in improvement in total length of stay and medical expenses. Furthermore, we also found an increased risk of gallbladder gangrene and perforation in LC >7 days after ERCP. LC within 7 days and even 3 days after ERCP is a safe, effective, and economical method for patients with choledocholithiasis and gallstones.
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Affiliation(s)
- Huan Liu
- Department of General Surgery, Zhongshan Hospital of Traditional Chinese Medicine, Zhongshan City, China
- * Correspondence: Huan Liu, Department of General Surgery, Zhongshan Hospital of Traditional Chinese Medicine, No. 3 Kangxin Rd., West District, Zhongshan City, Guangdong Province 528400, China (e-mail: )
| | - Wenjun Pan
- Department of General Surgery, Liaoyang Central Hospital, China Medical University, Liaoyang City, Liaoning Province, China
| | - Guoqiang Yan
- Department of General Surgery, Liaoyang Central Hospital, China Medical University, Liaoyang City, Liaoning Province, China
| | - Zhongmin Li
- Department of General Surgery, Liaoyang Central Hospital, China Medical University, Liaoyang City, Liaoning Province, China
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Optimal Timing of Cholecystectomy in Secondary Choledocholithiasis Patients Who Underwent Preoperative Endoscopic Retrograde Cholangiopancreatography. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12094574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Secondary choledocholithiasis occurs when stones leave the gallbladder. After therapeutic endoscopic retrograde cholangiopancreatography (ERCP) with stone removal, cholecystectomy should be performed to prevent recurrence. However, the optimal timing for cholecystectomy in secondary choledocholithiasis patients is unclear. The aim of this study was to determine the optimal timing for laparoscopic cholecystectomy in patients with secondary choledocholithiasis. In total, 22,996 patients in the Taiwan National Health Insurance Research Database (NHIRD) who underwent laparoscopic cholecystectomy for acute cholecystitis from 1998–2015 were divided into three groups according to whether they underwent surgery as an inpatient (early cholecystectomy (ELC)), within 2 months of admission (intermediate cholecystectomy (ILC)), or 2 months after admission (delayed cholecystectomy (DLC)). The primary outcomes included the recurrence, complication, and mortality rates. After adjusting for confounders, according to the 2013 Tokyo guidelines (cut-off at 2013), a subgroup analysis showed that, compared to the ELC group, the ILC group had lower recurrence, complication, and mortality rates, whereas the DLC group exhibited statistically significantly higher recurrence and mortality rates. In conclusion, the optimal timing of cholecystectomy in secondary choledocholithiasis patients after preoperative ERCP is within 2 months (ILC) after hospital admission. Moreover, ELC is associated with a measurable risk of complications.
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[Temporal sequence of bile duct clearance with simultaneous cholecystolithiasis or choledocholithiasis-Preoperative, intraoperative or postoperative?]. Chirurg 2022; 93:542-547. [PMID: 35107623 DOI: 10.1007/s00104-022-01583-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2022] [Indexed: 02/07/2023]
Abstract
Approximately 10% of patients with symptomatic cholecystolithiasis also have choledocholithiasis. The probability of this can be estimated on the basis of sonographic and laboratory chemistry parameters. If the probability is high, endoscopic retrograde cholangiography (ERC) or cholangiopancreatography (ERCP) should be performed and if the probability is low, cholecystectomy can be performed without further diagnostics. If the findings are equivocal, further work-up should be performed to detect or exclude choledocholithiasis by endoscopic ultrasound (EUS) or magnetic resonance cholangiopancreatography (MRCP). If choledocholithiasis is detected, it can be treated by ERC preoperatively, intraoperatively or postoperatively or alternatively by laparoscopic cholangiography. Regarding the temporal sequence, there is no clear advantage of a specific time point; however, considering the high availability of ERCP in German-speaking countries, preoperative clearance of choledocholithiasis seems reasonable. With respect to the time interval between clearance of choledocholithiasis and cholecystectomy, a number of multicenter studies and a meta-analysis have shown that a short time interval or a procedure during the same period of hospitalization is advantageous.
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RECURRENT BILIARY EVENTS IN PATIENTS, WHO UNDERWENT ENDOSCOPIC LITHOEXTRACTION DUE TO OBSTRUCTIVE JAUNDICE. WORLD OF MEDICINE AND BIOLOGY 2022. [DOI: 10.26724/2079-8334-2022-1-79-59-62] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
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Banker A, Prajapati R, Vairagar S, Khajanchi M. Optimal timing of laparoscopic cholecystectomy post-endoscopic retrograde cholangiography and common bile duct clearance: A prospective observational study. J Minim Access Surg 2022; 18:438-442. [PMID: 35708388 PMCID: PMC9306127 DOI: 10.4103/jmas.jmas_321_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: The treatment of patients with cholelithiasis with common bile duct (CBD) stones is CBD clearance with cholecystectomy. While traditional teachings advocate waiting for 4–6-week post-endoscopic retrograde cholangiography (ERCP) with CBD clearance, recent studies favour an early laparoscopic cholecystectomy (LC). Hence, this study was conducted to evaluate the optimal timing of LC post-ERCP. Methods: We conducted a prospective observational study between March 2017 and October 2018. Patients diagnosed with cholelithiasis and CBS stones on ultrasonography or computed tomography were included. They were assigned to one of two groups (<2 weeks and >2 weeks) based on the time interval between ERCP and subsequent LC. Chi-square test was used to analyse the intraoperative and post-operative outcomes between the two study groups, Results: One hundred and forty patients were included in the study of which 69 underwent an early LC (<2 weeks). There was a significant decrease in the blood loss and incidence of bowel injury in the early group. Calots triangle was better defined and critical view of safety was achieved more in the patients who underwent an early LC. This resulted in a significantly lower incidence of drain placement and length of hospital stay in those patients who underwent an early LC. Conclusion: A delay of 2 weeks after ERCP makes the LC more difficult and is associated with a longer hospital stay. We advocate LC within 2 weeks of ERCP whenever feasible.
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Ali RF, Aouf A, Isamil K, Ismail T, Elbatae H. Randomized Controlled Clinical Trial of Early vs Delayed Laparoscopic Cholecystectomy after CBD Stone Clearance. Indian J Surg 2021. [DOI: 10.1007/s12262-020-02607-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Clinical Impact of Preoperative Relief of Jaundice Following Endoscopic Retrograde Cholangiopancreatography on Determining Optimal Timing of Laparoscopic Cholecystectomy in Patients with Cholangitis. J Clin Med 2021; 10:jcm10194297. [PMID: 34640314 PMCID: PMC8509117 DOI: 10.3390/jcm10194297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 08/29/2021] [Accepted: 09/13/2021] [Indexed: 12/07/2022] Open
Abstract
Background: About 10% of patients with gallbladder (GB) stones also have concurrent common bile duct (CBD) stones. Laparoscopic cholecystectomy (LC) after removal of CBD stones using endoscopic retrograde cholangiopancreatography (ERCP) is the most widely used method for treating coexisting gallbladder and common bile duct stones. We evaluated the optimal timing of LC after ERCP according to clinical factors, focusing on preoperative relief of jaundice. Methods: A total of 281 patients who underwent elective LC after ERCP because of choledocholithiasis and cholecystolithiasis from January 2010 to April 2018 were retrospectively reviewed. We compared the hospital stay, perioperative morbidity, and rate of surgical conversion to open cholecystectomy according to the relief of jaundice before surgery. These enrolled patients were divided into two groups: relief of jaundice before surgery (group 1, n = 125) or not (group 2, n = 156). Results: The initial total bilirubin level was higher in group 1; however, there were no significant differences in the other baseline characteristics including age, sex, American Society of Anesthesiologists score, previous surgical history, white blood cell count, C-reactive protein, and operative time between the two groups. There was also no significant difference in postoperative hospital stay between the two groups (4.5 ± 3.3 vs. 5.5 ± 5.6 days, p = 0.087). However, after ERCP, the waiting time until LC was significantly longer in group 1 (5.0 ± 4.9 vs. 3.5 ± 2.4 days, p < 0.001). There were no statistical differences in the conversion rate (3.2% vs. 3.8%, p = 0.518) or perioperative morbidity (4.0% vs. 5.8%, p = 0.348), either. Conclusions: LC would not be delayed until the relief of jaundice after ERCP since there were no significant differences in perioperative morbidity or surgical conversion rate to open cholecystectomy. Early LC after ERCP may be feasible and safe in patients with cholangitis and cholecystolithiasis.
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Hoilat GJ, Hoilat JN, Abu-Zaid A, Raleig J, Tot J, Mandal A, Sostre V, Carvounis C, Sapkota B. Impact of early cholecystectomy on the readmission rate in patients with acute gallstone cholangitis: a retrospective single-centre study. BMJ Open Gastroenterol 2021; 8:bmjgast-2021-000705. [PMID: 34330787 PMCID: PMC8327811 DOI: 10.1136/bmjgast-2021-000705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 07/18/2021] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND AND AIMS The pathogenesis of acute cholangitis (AC) occurs with biliary obstruction followed by bacterial growth in the bile duct. The leading cause of AC is obstructing gallstones. There have been conflicting theories about the optimal timing for cholecystectomy following AC. The aim of this study is to assess the impact of early cholecystectomy on the 30-day readmission rate, 30-day mortality, 90-day readmission rate and the length of hospital stay. METHODS This retrospective study was performed between January 2015 and January 2021 in a high-volume tertiary referral teaching hospital. Included patients were 18 years or older with a definitive diagnosis of acute gallstone cholangitis who underwent endoscopic retrograde cholangiopancreatography (ERCP) with complete clearance of the bile duct as an index procedure. We divided the patients into two groups: patients who underwent ERCP alone and those who underwent ERCP with laparoscopic cholecystectomy (LC) on the same admission (ERCP+LC). Data were extracted from electronic medical records. The primary endpoint of the study was the 30-day readmission rate. RESULTS A total of 114 patients with AC met the inclusion criteria of the study. The ERCP+LC group had significantly lower rates of 30-day readmission (2.2% vs 42.6%, p<0.001), 90-day readmission (2.2% vs 30.9%, p<0.001) and 30-day mortality (2.2% vs 16.2%, p=0.017) when compared with the ERCP group. In a multivariate logistic regression analysis, patients in the ERCP+LC group had 90% lower odds of 30-day readmission compared with patients who did not undergo LC during admission (OR=0.1, 95% CI (0.032 to 0.313), p<0.001). CONCLUSION Performing LC on same day admission was associated with a decrease in 30-day and 90-day readmission rate as well as 30-day mortality.
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Affiliation(s)
- Gilles Jadd Hoilat
- Internal Medicine, SUNY Upstate Medical University, Syracuse, New York, USA
| | | | - Ahmed Abu-Zaid
- Department of Pharmacology, The University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Julia Raleig
- Department of Medicine, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Joseph Tot
- Department of Medicine, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Amrenda Mandal
- Gastroenterology, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Vanessa Sostre
- Gastroenterology, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Christos Carvounis
- Internal Medicine, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Bishnu Sapkota
- Gastroenterology, SUNY Upstate Medical University, Syracuse, New York, USA.,Gastroenterology, Syracuse VA Medical Center, Syracuse, New York, USA
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Abdalkoddus M, Franklyn J, Ibrahim R, Yao L, Zainudin N, Aroori S. Delayed cholecystectomy following endoscopic retrograde cholangio-pancreatography is not associated with worse surgical outcomes. Surg Endosc 2021; 36:2987-2993. [PMID: 34231064 PMCID: PMC8259777 DOI: 10.1007/s00464-021-08593-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 06/06/2021] [Indexed: 01/18/2023]
Abstract
BACKGROUND There is no universal consensus on the optimal timing of cholecystectomy following endoscopic retrograde cholangio-pancreatography (ERCP). This study aims to evaluate the effect of time delay and post-ERCP complications on cholecystectomy outcomes. MATERIALS AND METHODS All patients who underwent pre-op ERCP for concurrent cholelithiasis and choledocholithiasis between January 2009 and August 2019 at University Hospitals Plymouth, UK, were included. Patients who underwent single-stage cholecystectomy and common bile duct exploration were excluded from the study. Based on the delay to cholecystectomy, the patients were divided into early (within 2 weeks), intermediate (2-6 weeks) and late (> 6 weeks) groups. The operative outcomes between the three groups were compared. RESULTS We included 444 patients in the study, with 62 (14%), 90 (20%) and 292 (66%) patients in the early, intermediate and late groups, respectively. The median duration from ERCP to cholecystectomy was 75 days. There was no statistically significant difference in the conversion-to-open rate, bile leak rate or retained stones between the three groups. The median post-operative hospital stay (PHS) was 2, 2 and 1 day (P = 0.005) in the early, intermediate and late groups, respectively. The readmission rate was significantly more in the delayed group (3.2%, 11.1% and 13.7%; P = 0.05). Patients who suffered post-ERCP complications had a significantly longer PHS (4 vs 1 day, P = 0.001) and had higher conversion-to-open rate (16 vs 4.5%, P = 0.04). CONCLUSION Delayed cholecystectomy following ERCP is not associated with worse peri-operative outcomes and can facilitate more day-case surgery. However, early cholecystectomy can significantly reduce readmissions with gallstone-related symptoms and its associated hospital stay. Post-ERCP complications lead to a difficult cholecystectomy.
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Affiliation(s)
| | - Joshua Franklyn
- Peninsula HPB Unit, University Hospitals Plymouth NHS Trust, England, UK
| | - Rashid Ibrahim
- Peninsula HPB Unit, University Hospitals Plymouth NHS Trust, England, UK
| | - Lu Yao
- Peninsula HPB Unit, University Hospitals Plymouth NHS Trust, England, UK
| | - Nur Zainudin
- Peninsula HPB Unit, University Hospitals Plymouth NHS Trust, England, UK
| | - Somaiah Aroori
- Peninsula HPB Unit, University Hospitals Plymouth NHS Trust, England, UK
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Tracy BM, Paterson CW, Kwon E, Mlaver E, Mendoza A, Gaitanidis A, Rattan R, Mulder MB, Yeh DD, Gelbard RB. Outcomes of same admission cholecystectomy and endoscopic retrograde cholangiopancreatography for common bile duct stones: A post hoc analysis of an Eastern Association for the Surgery of Trauma multicenter study. J Trauma Acute Care Surg 2021; 90:673-679. [PMID: 33405473 DOI: 10.1097/ta.0000000000003057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND The optimal timing for cholecystectomy after endoscopic retrograde cholangiopancreatography (ERCP) for common bile duct (CBD) stones is unknown. We hypothesized that a delay between procedures would correlate with more biliary complications and longer hospitalizations. METHODS We prospectively identified patients who underwent same admission cholecystectomy after ERCP for CBD stones from 2016 to 2019 at 12 US medical centers. The cohort was stratified by time between ERCP and cholecystectomy: ≤24 hours (immediate), >24 to ≤72 hours (early), and >72 hours (late). Primary outcomes included operative duration, postoperative length of stay, (LOS), and hospital LOS. Secondary outcomes included rates of open conversion, CBD explorations, biliary complications, and in-hospital complications. RESULTS For the 349 patients comprising the study cohort, 33.8% (n = 118) were categorized as immediate, 50.4% (n = 176) as early, and 15.8% (n = 55) as late. Rates of CBD explorations were lower in the immediate group compared with the late group (0.9% vs. 9.1%, p = 0.01). Rates of open conversion were lower in the immediate group compared with the early group (0.9% vs. 10.8%, p < 0.01) and in the immediate group compared with the late group (0.9% vs. 10.9%, p < 0.001). On a mixed-model regression analysis, an immediate cholecystectomy was associated with a significant reduction in postoperative LOS (β = 0.79; 95% confidence interval, 0.65-0.96; p = 0.02) and hospital LOS (β = 0.68; 95% confidence interval, 0.62-0.75; p < 0.0001). CONCLUSION An immediate cholecystectomy following ERCP correlates with a shorter postoperative LOS and hospital LOS. Rates of CBD explorations and conversion to open appear more common after 24 hours. LEVEL OF EVIDENCE Therapeutic, level III.
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Affiliation(s)
- Brett M Tracy
- From the Department of Surgery (B.M.T.), The Ohio State University Wexner Medical Center, Columbus, Ohio; Department of Surgery (C.W.P., E.M., R.B.G.), Emory University School of Medicine; Division of Acute Care Surgery (C.W.P., R.B.G.), Grady Memorial Hospital, Atlanta, Georgia; Department of Surgery (E.K.), Loma Linda University Medical Center, Loma Linda, California; Department of Surgery (A.M., A.G.), Massachusetts General Hospital, Boston, Massachusetts; and Department of Surgery (R.R., M.B.M., D.D.Y.), Jackson Memorial Hospital, University of Miami Health System, Miami, Florida
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McCarty TR, Farrelly J, Njei B, Jamidar P, Muniraj T. Role of Prophylactic Cholecystectomy After Endoscopic Sphincterotomy for Biliary Stone Disease: A Systematic Review and Meta-analysis. Ann Surg 2021; 273:667-675. [PMID: 32590541 DOI: 10.1097/sla.0000000000003977] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE The aim of this study was to perform a structured systematic review and meta-analysis to evaluate the effectiveness and complication rate of cholecystectomy deferral versus prophylactic cholecystectomy among patients post-endoscopic biliary sphincterotomy for common bile duct stones. BACKGROUND Although previous reports suggest a decreased risk of biliary complications with prophylactic cholecystectomy, biliary endoscopic cholangiopancreatography (ERCP) with sphincterotomy may provide a role for deferring cholecystectomy with the gallbladder left in situ. METHODS Searches of PubMed, EMBASE, Web of Science, and Cochrane Library databases were performed through August 2019 in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Meta-Analysis of Observational Studies in Epidemiology guidelines. Measured outcomes included: mortality, recurrent biliary pain or cholecystitis, pancreatitis, cholangitis, and eventual need for cholecystectomy. Random effects models were used to determine pooled effect size and corresponding 95% confidence intervals (CIs). RESULTS Nine studies (n = 1605) were included. A total of 53.8% (n = 864) patients had deferred cholecystectomy post-sphincterotomy. Deferral cholecystectomy as compared to prophylactic cholecystectomy resulted in a significant increased risk of mortality [odds raio (OR) 2.56 (95% confidence interval, CI 1.54-4.23); P < 0.0001; I2 = 18.49]. Patients who did not undergo prophylactic cholecystectomy developed more recurrent biliary pain or cholecystitis [OR 5.10 (95% CI 3.39-7.67); P < 0.0001; I2 = 0.00]. Rate of pancreatitis [OR 3.11 (95% CI 0.99-9.83); P = 0.053; I2 = 0.00] and cholangitis [OR 1.49 (95% CI 0.74-2.98); P = 0.264; I2 = 0.00] was unaffected. Overall, 26.00% (95% CI 14.00-40.00) of patients with deferred prophylactic cholecystectomy required eventual cholecystectomy. CONCLUSIONS Prophylactic cholecystectomy remains the preferred strategy compared to a deferral approach with gallbladder in situ post-sphincterotomy for patients with bile duct stones. Future studies may highlight a subset of patients (ie, those with large balloon biliary dilation) that may not require cholecystectomy.
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Affiliation(s)
- Thomas R McCarty
- Division of Gastroenterology, Hepatology and Endoscopy. Brigham and Women's Hospital. Boston, MA
- Harvard Medical School, Boston, MA
| | - James Farrelly
- Section of General Surgery, Trauma, and Critical Care, Yale University School of Medicine. New Haven, CT
| | - Basile Njei
- Section of Digestive Diseases, Yale University School of Medicine. New Haven, CT
| | - Priya Jamidar
- Section of Digestive Diseases, Yale University School of Medicine. New Haven, CT
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Merati-Kashani K, Canal C, Birrer DL, Clavien PA, Neuhaus V, Turina M. Nighttime Cholecystectomies are Safe When Controlled for Individual Patient Risk Factors-A Nationwide Case-Control Analysis. World J Surg 2021; 45:2058-2065. [PMID: 33738522 PMCID: PMC8154770 DOI: 10.1007/s00268-021-06021-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2021] [Indexed: 11/28/2022]
Abstract
Background The aim of this study was to evaluate if the time of day a cholecystectomy was performed affects in-hospital complication rates and mortality. Methods A national quality measurement database was retrospectively studied. Study period was 2010 to 2017. The inclusion criteria were operatively treated cholecystitis or another benign disease of the gallbladder. Further, the time of day the operation was performed must have been documented. We defined nighttime as all interventions performed between 7PM until 6AM. A total of 11′459 patients were included. Development of any complication during hospitalization and in-hospital mortality was the main outcomes. The first part of the study was solely descriptive. In the second part, we applied a 1:1 case–control-matching. A matched group of 274 pairs were further investigated. Results Only 8.4% of the procedures were performed during nighttime. Complications occurred in 6.7% of all patients. We found twice as many complications in the nighttime group compared to the daytime group. Mortality was 0.56% during daytime and 0.52% during nighttime. In a matched-pair analysis, however, we found no significant differences in the overall mortality rate nor in the occurrence of complications when comparing day- vs. nighttime operations. Conclusions We found twice as many complications in the nighttime group (12%) compared to the daytime group (6.1%), mainly related to patient risk factors. In contrast to common apprehension, however, nighttime cholecystectomies were not associated with higher mortality rates. Supplementary Information The online version contains supplementary material available at 10.1007/s00268-021-06021-7.
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Affiliation(s)
- Kian Merati-Kashani
- Department of Surgery, Hospital of Maennedorf, Asylstrasse 10, CH-8708, Maennedorf, Switzerland
| | - Claudio Canal
- Division of Trauma Surgery, Department of Traumatology, University Hospital Zurich, University of Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland
| | - Dominique Lisa Birrer
- Department of General and Transplant Surgery, University Hospital Zurich, University of Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland
| | - Pierre-Alain Clavien
- Department of General and Transplant Surgery, University Hospital Zurich, University of Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland
| | - Valentin Neuhaus
- Division of Trauma Surgery, Department of Traumatology, University Hospital Zurich, University of Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland
| | - Matthias Turina
- Department of General and Transplant Surgery, University Hospital Zurich, University of Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland.
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The Impact of Laparoscopic Cholecystectomy on 30-Day Readmission Rate for Acute Cholangitis Patients: A Single-Center Study. Dig Dis Sci 2021; 66:861-865. [PMID: 32248392 DOI: 10.1007/s10620-020-06240-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 03/25/2020] [Indexed: 01/16/2023]
Abstract
OBJECTIVES Laparoscopic cholecystectomy (LC) following acute gallstone cholangitis reduces the recurrence of biliary symptoms; however, the timing of LC has not been determined yet. The aim of our study was to evaluate the impact of performing LC during admission on the 30-day readmission rate. METHODS We conducted a retrospective cohort study of acute gallstone cholangitis patients who underwent endoscopic clearance (EC) of the bile duct through endoscopic retrograde cholangiopancreatography between April 2013 and May 2018. Patients were classified into two groups: EC only group and EC followed by LC during admission (EC + LC) group. The primary outcome was the 30-day readmission rate. RESULTS A total of 95 patients with acute cholangitis were included in the analysis. Of these patients, 35 patients (36.8%) underwent LC during admission. The 30-day readmission rate was significantly lower in the EC + LC group compared to the EC group (2.9% vs. 26.7%, P 0.003). In a multivariate regression analysis, patients who underwent LC during admission had 90% lower odds of readmission within 30 days compared to patients who did not (OR 0.1, 95% CI (0.01-0.9), P 0.04). CONCLUSIONS Performing laparoscopic cholecystectomy during admission for acute gallstone cholangitis patients following endoscopic clearance of the bile duct significantly reduced the 30-day readmission rate without affecting the length of stay.
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Goel A, Kothari S, Bansal R. Comparative Analysis of Early versus Late Laparoscopic Cholecystectomy Following Endoscopic Retrograde Cholangiopancreaticography in Cases of Cholelithiasis with Choledocholithiasis. Euroasian J Hepatogastroenterol 2021; 11:11-13. [PMID: 34316458 PMCID: PMC8286358 DOI: 10.5005/jp-journals-10018-1338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Introduction A preferred treatment for cholelithiasis with choledocholithiasis is endoscopic retrograde cholangiopancreaticography (ERCP) followed by laparoscopic cholecystectomy (LC), which can be performed early (within 72 hours) or can be delayed for 6 to 8 weeks. This study is conducted to compare and analyze the outcome of early versus late LC following common bile duct (CBD) clearance by ERCP and determine the optimum timing for performing LC post-ERCP. Materials and methods This comparative analysis was conducted at St Joseph Hospital, Ghaziabad, from September 2019 to March 2021 on 89 cases of cholelithiasis with choledocholithiasis. Patients were divided into two groups. Group I (n = 45) patients underwent early LC within 72 hours post-ERCP and group II (n = 44) patients underwent late LC after an interval of 8 weeks. Various preoperative, perioperative, and postoperative clinical parameters like operative difficulty, complications, surgery duration, hospital stay, and conversion to open cholecystectomy were analyzed. Results There was no significant difference in demographic and laboratory findings in both groups. Group I patients had significantly shorter hospital stay and less operative difficulty. The duration of surgery was significantly low in group I. There was no significant difference in rate of conversion to open cholecystectomy. Conclusion Early LC post-ERCP is associated with short hospital stay and duration of surgery and less operative difficulty and complications. Therefore, we recommend that LC can be safely performed within 48 to 72 hours after ERCP. How to cite this article Goel A, Kothari S, Bansal R. Comparative Analysis of Early versus Late Laparoscopic Cholecystectomy Following Endoscopic Retrograde Cholangiopancreaticography in Cases of Cholelithiasis with Choledocholithiasis. Euroasian J Hepato-Gastroenterol 2021;11(1):11–13.
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Affiliation(s)
- Apoorv Goel
- Department of General Surgery, St Joseph Hospital, Ghaziabad, Uttar Pradesh, India
| | - Shyam Kothari
- Department of General Surgery, St Joseph Hospital, Ghaziabad, Uttar Pradesh, India
| | - Roli Bansal
- Department of Medicine, Division of Nephrology, UCMS & GTB Hospital, New Delhi, India
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Arroyave Guerrero YA, Torres Velasco FA, Sarzosa Verona FS, Díaz JD. ¿Es más difícil la colecistectomía laparoscópica después de una colangiopancreatografía retrógrada endoscópica? Experiencia en un hospital de tercer nivel. REVISTA COLOMBIANA DE CIRUGÍA 2020. [DOI: 10.30944/20117582.781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022] Open
Abstract
Introducción. La colecistectomía laparoscópica es el tratamiento estándar para la colecistitis aguda. En pacientes con coledocolitiasis, la colangiopancreatografía retrógrada endoscópica es el tratamiento de elección. Se ha reportado que, después de este procedimiento endoscópico, la colecistectomía laparoscópica es más difícil y son mayores las tasas de conversión, hemorragia y tiempo operatorio. El objetivo de este estudio fue determinar si en nuestro medio las colecistectomías laparoscópicas posteriores a este procedimiento endoscópico presentan más complicaciones posquirúrgicas y mayor dificultad técnica.
Métodos. Estudio de cohorte prospectivo, en el que se comparó un grupo de pacientes sometidos a colecistectomía laparoscópica previa colangiopancreatografía retrógrada endoscópica, contra un grupo homogéneo de pacientes sin colangiografía previa, para evaluar la dificultad en la colecistectomía laparoscópica, la conversión, la reintervención y las complicaciones.
Resultados. El 45,4 % de las cirugías fueron difíciles. No hay relación entre la realización previa de colangiopancreatografía retrógrada endoscópica y la dificultad de la colecistectomía laparoscópica. Con el modelo de regresión logística, se encontraron como factores predictores para una cirugía difícil, la edad, el sexo masculino, la cirugía abdominal previa, la colecistitis aguda y la mayor gravedad de la colecistitis aguda.
Conclusión. La colangiopancreatografía retrógrada endoscópica en nuestro medio no constituye un factor de riesgo para dificultad en la colecistectomía laparoscópica. Debe prestarse especial cuidado al sexo masculino, la gravedad de la colecistitis aguda, los antecedentes de cirugía abdominal y la presencia de comorbilidades a la hora de planear una colecistectomía laparoscópica, tomando precauciones adicionales en estos casos para prevenir complicaciones.
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Zhang M, Hu W, Wu M, Ding G, Lou S, Cao L. Timing of early laparoscopic cholecystectomy after endoscopic retrograde cholangiopancreatography. LAPAROSCOPIC, ENDOSCOPIC AND ROBOTIC SURGERY 2020. [DOI: 10.1016/j.lers.2020.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
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Zhumatayev DT, Baimakhanov АN, Abdykadyrov MK, Nurmakov DA, Raimkhanov AD, Smagulov АM, Abdiyev NM. Simultaneous surgical treatment tactics of acute destructive cholecystitis combined with choledocholithiasis: A case report. Int J Surg Case Rep 2020; 70:230-233. [PMID: 32422585 PMCID: PMC7231816 DOI: 10.1016/j.ijscr.2020.04.081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 04/12/2020] [Accepted: 04/27/2020] [Indexed: 12/24/2022] Open
Abstract
Acute destructive cholecystitis complicated by choledocholithiasis in elderly patients. A one-stage operation in acute cholecystitis when complicated by choledocholithiasis. Performance of LCE after ERCP with EPST in acute cholecystitis when complicated by choledocholithiasis.
Introduction The widespread development of minimally invasive treatment methods have expanded the choices and options available to surgeons to manage patients suffering from cholelithiasis and its complications, including choledocholithiasis. As new surgical strategies are developed and become widely available, there is an ongoing debate as to which surgical strategies are optimal for the management of acute cholecystitis and concomitant choledocholithiasis. The treatment of patients in this category should be carried out according to clear criteria, taking into consideration the patient's condition, concomitant diseases, the size of calculi in the common bile duct as well as the resources of the medical institution. Case presentation We present the clinical case of a 65-year-old female with cholelithiasis, acute gangrenous cholecystitis, choledocholithiasis, and obstructive jaundice. She was treated with endoscopic retrograde cholangiopancreatography (ERCP) with endoscopic papillosphincterotomy (EPST) and laparoscopic cholecystectomy (LCE) in a one-stage operation. Discussion Several sources recommended performing LCE after ERCP with EPST in acute cholecystitis when complicated by choledocholithiasis to reduce the conversion rate and the risk of recholedocholithiasis. Conclusion Simultaneous resolution of acute destructive cholecystitis complicated by choledocholithiasis in a one-stage operation is accompanied by a decrease in emotional and psychological trauma, also leads to early rehabilitation of patients and, thereby, reduces overall postoperative disability and morbidity.
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Affiliation(s)
- Dauren T Zhumatayev
- Department of Surgery, Asfendiyarov Kazakh National Medical University, 050012 Almaty, Kazakhstan.
| | - Аbilay N Baimakhanov
- Department of Surgery, Asfendiyarov Kazakh National Medical University, 050012 Almaty, Kazakhstan
| | | | - Dauren A Nurmakov
- Department of Surgery, Asfendiyarov Kazakh National Medical University, 050012 Almaty, Kazakhstan
| | - Aidar D Raimkhanov
- Department of Surgery, Asfendiyarov Kazakh National Medical University, 050012 Almaty, Kazakhstan
| | | | - Nurken M Abdiyev
- Department of Surgery, Asfendiyarov Kazakh National Medical University, 050012 Almaty, Kazakhstan; City Clinical Hospital No. 4, 050054 Almaty, Kazakhstan
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Chen Q, Zhang Y, Li S, Chen S, Lin X, Li C, Asakawa T. Mechanisms Underlying the Prevention and Treatment of Cholelithiasis Using Traditional Chinese Medicine. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2019; 2019:2536452. [PMID: 31316569 PMCID: PMC6601506 DOI: 10.1155/2019/2536452] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 05/17/2019] [Accepted: 06/02/2019] [Indexed: 01/14/2023]
Abstract
Cholelithiasis is a major public health concern that necessitates highly effective, feasible, and recurrence-preventing therapies. Currently available surgical treatments and medications cannot effectively avoid the recurrence of cholelithiasis. Hence, several Chinese herbal compounds (CHCs) are considered for the treatment of cholelithiasis, considering that they can effectively discharge gallstones and prevent the recurrence of such condition. In the present narrative review, we aim to summarize the underlying mechanisms of currently used CHCs in the treatment of cholelithiasis and to describe the current situation of traditional Chinese medicine (TCM) use for cholelithiasis. Several commonly used CHCs were used to illustrate these issues. We found that the mechanisms underlying the CHC treatments rely on the amelioration of the biliary dynamics factors, maintenance and protection of the liver function, reduction of the cholesterol and bilirubin levels, and regulation of the inflammatory reactions. CHCs as treatments based on TCM can ameliorate the overall bodily function, thereby preventing the recurrence of cholelithiasis. Appropriate application of CHCs would be beneficial for patients and clinicians, although the safety and efficacy of CHCs need further verification.
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Affiliation(s)
- Qiliang Chen
- Research Base of Traditional Chinese Medicine Syndrome, Fujian University of Traditional Chinese Medicine, Fuzhou 350122, China
| | - Yuanyuan Zhang
- Research Base of Traditional Chinese Medicine Syndrome, Fujian University of Traditional Chinese Medicine, Fuzhou 350122, China
| | - Shunan Li
- Research Base of Traditional Chinese Medicine Syndrome, Fujian University of Traditional Chinese Medicine, Fuzhou 350122, China
| | - Shujiao Chen
- Research Base of Traditional Chinese Medicine Syndrome, Fujian University of Traditional Chinese Medicine, Fuzhou 350122, China
| | - Xuejuan Lin
- Research Base of Traditional Chinese Medicine Syndrome, Fujian University of Traditional Chinese Medicine, Fuzhou 350122, China
| | - Candong Li
- Research Base of Traditional Chinese Medicine Syndrome, Fujian University of Traditional Chinese Medicine, Fuzhou 350122, China
| | - Tetsuya Asakawa
- Research Base of Traditional Chinese Medicine Syndrome, Fujian University of Traditional Chinese Medicine, Fuzhou 350122, China
- Department of Neurosurgery, Hamamatsu University School of Medicine, Handayama, Hamamatsu-City, Shizuoka, Japan
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In-hospital Pediatric Endoscopic Retrograde Cholangiopancreatography Is Associated With Shorter Hospitalization for Children With Choledocholithiasis. J Pediatr Gastroenterol Nutr 2019; 68:64-67. [PMID: 30044307 DOI: 10.1097/mpg.0000000000002102] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Children with choledocholithiasis are frequently managed at tertiary children's hospitals that do not have available endoscopic retrograde cholangiopancreatography (ERCP) proceduralists. We hypothesized that patients treated at hospitals without ERCP proceduralists would have a longer hospital length of stay (LOS) than those with ERCP proceduralists. METHODS Charts were reviewed for patients who underwent cholecystectomy and ERCP at 3 tertiary children's hospitals over 10 years. Trauma and complicated pancreatitis patients were excluded. Comparisons between patients requiring and not requiring transfer for ERCP were made using Wilcoxon rank-sum tests for continuous variables and Fisher's exact tests for categorical variables. RESULTS One hundred and sixty-four children underwent ERCP for suspected choledocholithiasis: 79 (48%) in the transfer group and 85 (52%) in the no transfer group.Median LOS was longer for patients requiring transfer (7 vs 5 days, P < 0.0001). One-third (34%) of the transfer patients had magnetic resonance cholangiopancreatography compared to only 7% that did not require transfer (P < 0.0001). Among the 123 patients who underwent ERCP before cholecystectomy, 53% required (66/123) transfer and 47% (57/123) did not. Transfer group patients had longer median hospital LOS (P < 0.0001), more days between admission and ERCP (P < 0.0001), and more days between ERCP and surgery (P = 0.0004). CONCLUSIONS Overall median LOS was significantly shorter for patients who underwent ERCP at the admitting facility. Patients who underwent ERCP before cholecystectomy at hospitals without available ERCP proceduralists incurred longer LOS. There is a need for more pediatric proceduralists appropriately trained to perform ERCP in children.
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