Early Versus Late Cholecystectomy After Clearance of Common Bile Duct Stones by Endoscopic Retrograde Cholangiopancreatography: A Prospective Randomized Study

Nakeeb, Ayman El; Ezzet, Helmy; Askar, Waleed; Hanafy, Ehab El; Hamdy, Emad; Atef, Ehab; Youssef, Mohamed A.; Talaat, Hussein; Hamed, Hosam; Abdallah, Talaat

doi:10.1097/sle.0000000000000265

Cited by 30 publications

(45 citation statements)

References 22 publications

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“…In the univariate analysis, significant differences were observed in the patients with an albumin level <3.5 g/dL, CRP level ≥5 mg/dL, moderate (grade II) or severe (grade III) acute cholecystitis according to the TG18 classification, and the CT attenuation around the gallbladder ≥1.4. In the .003 AST (IU/L) 20 [16,30] 24 [16,47] 27 [22,36] .093 ALT (IU/L) 20 [16,32] 25 [13,55] 24 [20,39] . multivariate analysis, CRP levels of ≥5 mg/dL and the CT attenuation around the gallbladder of ≥1.4 were identified as independent predictive factors of difficult surgical cases (Table 2).…”

Section: Resultsmentioning

confidence: 99%

“…4,[11][12][13][14][15][16][17][18] The superiority of early surgery was confirmed in studies of cholecystectomies after both the treatment of choledocholithiasis with endoscopic retrograde cholangiopancreatography and acute pancreatitis. [19][20][21][22][23] Consequently, surgery is recommended within 72 hours from the onset of acute cholecystitis. Abbreviations: γ-GTP, γ-glutamyl transpeptidase; ALP, alkaline phosphatase; ALT, alanine aminotransferase; AST, aspartate aminotransferase; CRP, C-reactive protein; CT, computed tomography; eGFR, estimated glomerular filtration rate; PLT, platelet count; TG, Tokyo guidelines; WBC, white blood count.…”

Section: Discussionmentioning

confidence: 99%

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Attenuation around the gallbladder on plain abdominal computed tomography as a predictor of surgical difficulty in laparoscopic cholecystectomy

Iida

Maehira

Mori

et al. 2021

Asian J Endoscop Surgery

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This study examined whether abdominal plain computed tomography (CT) can predict surgical difficulty in acute cholecystitis. Methods:We retrospectively analyzed 84 consecutive patients who underwent laparoscopic cholecystectomy for acute cholecystitis between January 2015 and December 2018. We distinguished three degrees of surgical difficulty based on the operative time and blood loss: difficult, both ≥120 minutes and ≥ 100 mL, respectively (n = 27); moderate, either ≥120 minutes or ≥ 100 mL, respectively (n = 30); and easy, both <120 minutes and < 100 mL, respectively (n = 27). We calculated the attenuation around the gallbladder on CT before surgery and compared the values among the three groups.Results: Mean age, albumin levels, C-reactive protein levels, and the CT attenuation around the gallbladder (P < .001) were significantly different between groups. The surgical difficulty was unrelated to the timing of surgery. The postoperative complications were more frequent in operations more than 72 hours after disease onset (P = .04) and with CT attenuation around the gallbladder of ≥1.4 (P = .036). Conclusion:High attenuation around the gallbladder on plain CT predicted a high surgical difficulty of laparoscopic cholecystectomy. We recommend measuring the CT attenuation around the gallbladder in patients with acute cholecystitis.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Attenuation around the gallbladder on plain abdominal computed tomography as a predictor of surgical difficulty in laparoscopic cholecystectomy

Iida

Maehira

Mori

et al. 2021

Asian J Endoscop Surgery

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“…[13,17,27] The cause of such high conversion rates is explained by that post-ES bile reflux and bacterial contamination cause inflammation and adhesions around the Calot's triangle and gallbladder. [12,25,28] In a study comparing the optimal time to achieve a better outcome, de Vries et al [9] found a higher rate of conversion (31%) in patients undergoing LC 2-6 weeks after the ERCP procedure. They determined that the conversion rate was 4% in patients undergoing LC in the first two weeks after ERCP, and the rate was 16% after >6 weeks.…”

Section: Discussionmentioning

confidence: 99%

“…Many studies have not specified any difference between groups concerning the rates of conversion to open surgery, but they have shown results showing the advantages of early cholecystectomy concerning other factors. El Nakeeb et al [28] conducted a study by dividing patients into two groups as early LC (within three days after ERCP) and late LC (one month after ERCP). They found no difference between the groups concerning the conversion rate.…”

Section: Discussionmentioning

confidence: 99%

Perioperative outcomes of the patients treated with laparoscopic cholecystectomy after emergent endoscopic retrograde cholangiopancreatography for bile duct stones: does timing matter?

Çelik¹

2020

Ulus Travma Acil Cerrahi Derg

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BACKGROUND:There is no consensus on the optimal timing for laparoscopic cholecystectomy (LC) after emergent endoscopic retrograde cholangiopancreatography (ERCP) for suspected choledocholithiasis. Although certain data suggest that an early interval or single-stage treatment by LC, together with laparoscopic bile duct exploration, has more favorable outcomes, delayed LC is most often preferred as the standard treatment of patients with gallstones and choledocholithiasis following ERCP due to lack of experience, necessary instrumentation, or organizational restrictions. This study aims to compare the effects of different time intervals between ERCP and LC on perioperative outcomes. METHODS:In this paper, preoperative and postoperative data from consecutive patients who were treated for common bile duct stones with emergent ERCP and then underwent LC were reviewed retrospectively. To evaluate the impacts of different time intervals on outcomes, patients were classified into three groups according to the duration from the last ERCP to LC: within two weeks (Group 1), between 2-6 weeks (Group 2), and over six weeks (Group 3). RESULTS:This study involved an analysis of 67 patients with a mean age of 52.8 years. Overall conversion rate was 20.0% in Group 1, 25.0% in Group 2, and 13.6% in Group 3 (p=0.646). The rate of conversion to open surgery was 25.0% in male patients and 14.2% in females. In addition, no significant difference was found between the groups concerning gender, comorbidities, laboratory and gallbladder features, operation time, and length of the hospital stay. The perioperative complication rate was found to be 17.9%; however, there was no significant difference between the three groups. CONCLUSION:Our results support that LC after ERCP is more complex and has higher conversion rates than LC for uncomplicated cholelithiasis. Although no significant effect of different time intervals between ERCP and LC on perioperative outcomes was demonstrated in patients with common bile duct stones concomitant with cholelithiasis, the 2-6 weeks after ERCP is a critical period for conversion to open surgery. It is recommended that LC after ERCP should be performed in the early period, considering that serious complications may occur in the late period and recurrent biliary attacks may occur.

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“…Patients with acute pancreatitis run the risk of a fatal episode whilst awaiting cholecystectomy that can be reduced by early biliary surgery. Concerns of complications resulting from conversion from laparoscopic to open surgery or increased risks of bile duct injury with emergency compared with delayed surgery are not supported by current evidence. Several studies have tried to identify the optimal time within the first week of admission, and some, though not all, have shown a lower conversion rate if surgery is possible within 72 h. Meta‐analysis of available studies has not shown a higher incidence of bile duct injury, which remains similar to that in patients having delayed surgery.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of a quality improvement collaborative in reducing time to surgery for patients requiring emergency cholecystectomy

et al. 2019

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BackgroundAcute gallstone disease is a high‐volume emergency general surgery presentation with wide variations in the quality of care provided across the UK. This controlled cohort evaluation assessed whether participation in a quality improvement collaborative approach reduced time to surgery for patients with acute gallstone disease to fewer than 8 days from presentation, in line with national guidance.MethodsPatients admitted to hospital with acute biliary conditions in England and Wales between 1 April 2014 and 31 December 2017 were identified from Hospital Episode Statistics data. Time series of quarterly activity were produced for the Cholecystectomy Quality Improvement Collaborative (Chole‐QuIC) and all other acute National Health Service hospitals (control group). A negative binomial regression model was used to compare the proportion of patients having surgery within 8 days in the baseline and intervention periods.ResultsOf 13 sites invited to join Chole‐QuIC, 12 participated throughout the collaborative, which ran from October 2016 to January 2018. Of 7944 admissions, 1160 patients had a cholecystectomy within 8 days of admission, a significant improvement (P < 0·050) from baseline performance. This represented a relative change of 1·56 (95 per cent c.i. 1·38 to 1·75), compared with 1·08 for the control group. At the individual site level, eight of the 12 Chole‐QuIC sites showed a significant improvement (P < 0·050), with four sites increasing their 8‐day surgery rate to over 20 per cent of all emergency admissions, well above the mean of 15·3 per cent for control hospitals.ConclusionA surgeon‐led quality improvement collaborative approach improved care for patients requiring emergency cholecystectomy.

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Early Versus Late Cholecystectomy After Clearance of Common Bile Duct Stones by Endoscopic Retrograde Cholangiopancreatography: A Prospective Randomized Study

Abstract: No significant difference between both groups as regards the conversion rate. Recurrent biliary symptoms were significantly more in delayed LC while waiting LC. Morbidity was significantly more in delayed LC.

Cited by 30 publications

References 22 publications

Attenuation around the gallbladder on plain abdominal computed tomography as a predictor of surgical difficulty in laparoscopic cholecystectomy

Attenuation around the gallbladder on plain abdominal computed tomography as a predictor of surgical difficulty in laparoscopic cholecystectomy

Perioperative outcomes of the patients treated with laparoscopic cholecystectomy after emergent endoscopic retrograde cholangiopancreatography for bile duct stones: does timing matter?

Effectiveness of a quality improvement collaborative in reducing time to surgery for patients requiring emergency cholecystectomy

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