Late two‐stage laparoscopic cholecystectomy is associated with an increased risk of major bile duct injury

Beliaev, Andrei M.; Booth, Michael

doi:10.1111/ans.12967

Cited by 7 publications

(7 citation statements)

References 19 publications

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“…A two-stage LC after 15 weeks following ERC/ES increases the rate of CTO three times (RR = 2.7, 95% CI: 1.4-5.5, P = 0.004) and major BDI 10-fold (RR = 10.2, 95% CI: 1.1-95.7, P = 0.043) [57]. Boerma et al compared the two-stage LC conducted within 6 weeks after ERC with that performed after 6 weeks and found that the latter was more technically demanding and associated with a threefold increase in the CTO rate (RR = 2.7, 95% CI: 1.3-3.4, P = 0.01) [58].…”

Section: Actual Problems Of Emergency Abdominal Surgerymentioning

confidence: 99%

Risk Factors and Predictive Models for Conversion of Laparoscopic Cholecystectomy to Open Surgery, and Surgical Quality Outcome Measures

Beliaev¹,

Booth²

2016

Actual Problems of Emergency Abdominal Surgery

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Background: Laparoscopic cholecystectomy is the preferred surgical operation for symptomatic gallstone disease. Conversion of laparoscopic cholecystectomy to open surgery is used to prevent intra-abdominal organ injury, for open common bile duct exploration and to repair intra-abdominal organ injury. Objective:The objective of this chapter is to review risk factors and predictive models for conversion of laparoscopic cholecystectomy to open surgery, and surgical quality outcome measures. Methods:A narrative literature review using Pubmed, Medline, Cochrane library databases and Google search engine is described.Results: From the literature review, patient-and surgeon-related risk factors and predictive models for conversion of laparoscopic cholecystectomy to open surgery were identified. Patient-dependent risk factors included preoperative and intraoperative variables. Current conversion of laparoscopic cholecystectomy to open surgery predictive models use only patient-dependent risk factors and were not tested on an independent sample of patients. Surgical quality outcome measures incorporate an association between conversion and intra-abdominal organ injury that demonstrates that conversion was used as an emergency strategy to repair injuries rather than a safety measure. Conclusion:Conversion of laparoscopic cholecystectomy to open surgery risk stratification based on patient-and surgeon-dependent variables may allow a better management of the patient to keep conversion at low rates and to maintain benefits of minimally invasive surgery.

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Section: Actual Problems Of Emergency Abdominal Surgerymentioning

confidence: 99%

Risk Factors and Predictive Models for Conversion of Laparoscopic Cholecystectomy to Open Surgery, and Surgical Quality Outcome Measures

Beliaev¹,

Booth²

2016

Actual Problems of Emergency Abdominal Surgery

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“…Our conversion rate was lower than that in the previous literature. 31 Male gender, older age (>50 years), obese patients (body mass index > 30 kg/m 2 ), and case performed by low-volume surgeons had a higher likelihood to conversion in overall LC, [31][32][33] However, there was no single factor related to preoperative ERCP that would make LC more difficult except the number of ERCPs. 34,35 In our study, we found a higher age of patient and a larger proportion of difficult stone in the conversion group with statistical significance.…”

Section: Discussionmentioning

confidence: 99%

Factors Associated with the Success Rate of Endoscopic Retrograde Cholangiopancreatography with Standard Technique followed by Laparoscopic Cholecystectomy in the Management of Choledocholithiasis: A Single-Center Experience

Konsue

Eurboonyanun

Ruangwannasak

et al. 2020

Journal of Digestive Endoscopy

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Abstract Background Choledocholithiasis is the most common benign biliary disease. Endoscopic retrograde cholangiopancreatography (ERCP) followed by laparoscopic cholecystectomy (LC) has been the first-line therapy in recent years, although laparoscopic common bile duct exploration has promising results. This retrospective study aimed to define the factors associated with biliary clearance by standard ERCP technique and conversion rate of LC. Materials and Methods We retrospectively evaluated the records of 217 choledocholithiasis patients who had undergone ERCP with stone removal by the standard technique from 2010 to 2018. A failed ERCP was defined when the first ERCP session could not remove the stones . The number of patients who later underwent open cholecystectomy or LC was also recorded. Conversion was defined when LC had to be converted OC. Statistical Analysis Student’s t-test was used for the comparison of continuous variables. Nominal variables were analyzed using Pearson’s chi-square test or Fisher’s exact test. Binary logistic regression was performed for multivariate analysis. Results The rate of successful biliary clearance was 81.1%. Of the patients, 109 (50.2%) had difficult stones. Increasing age (p = 0.004), increasing number (p = 0.001), and increasing size of stone (p < 0.001) were the three significant factors that were associated with the failure of biliary clearance. The difficult stone group had a higher failure rate of ERCP and a higher conversion rate of LC compared with the easy stone group (p = 0.001 and p = 0.027, respectively). Conclusions ERCP with the standard technique is a highly effective and safe management option for patients with common bile duct (CBD) stones. The difficult stone group was found to be an independent risk factor that affected the success rate of both ERCP and the following LC. Difficult stone criteria should be assessed to identify a patient who might benefit from laparoscopic CBD exploration.

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“…Patients with cholelithiasis and choledocholithiasis require treatment of both of these entities. [13,15,16] Although there are several strategies for the treatment of combined choledochocystolithiasis, a commonly used strategy to treat patients is the two-stage management using preoperative ERCP with endoscopic sphincteroplasty and CBD stone removal followed by an interval LC. [3,9,17,18] With the widespread adoption of laparoscopy, single-stage treatments, such as CBD exploration and LERV techniques, have evolved with LC.…”

Section: Discussionmentioning

confidence: 99%

“…However, this time interval be-Şenocak et al Perioperative outcomes of the patients treated using LC after emergent ERCP for bile duct stones tween ERCP and LC ranges from days to months. [9,15,21] When viewed from this perspective, there is a paradoxical problem that needs to be resolved because a single-stage operation requires experience, and a two-stage operation has the risk of leading to recurrent attacks and increased complication rates if not carried out within the appropriate time frame. In this study, we analyzed the intraoperative and postoperative outcomes of the patients undergoing LC at three different time intervals after emergent ERCP.…”

Section: Discussionmentioning

confidence: 99%

“…Another point that stood out in the studies that were examined was that there were differences regarding the incidence of complications, such as perioperative uncontrolled bleeding, gallbladder rupture, CBD injury and bile leakage from the bed or the cystic stump concerning time intervals after ERCP. [9,11,30] Beliaev et al [15] conducted a study examining the effects of LCs performed at different time intervals after ERCP on the ratio of major bile duct injuries, where the late (≥16 weeks) LC was found to be associated with a 10-fold increase in major bile duct injuries. In our study, there was no statistically significant difference in perioperative complications among the patients who underwent LC >2 weeks, 2-6 weeks and >6 weeks after ERCP.…”

Section: Discussionmentioning

confidence: 99%

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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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Late two‐stage laparoscopic cholecystectomy is associated with an increased risk of major bile duct injury

Abstract: General surgeons should be aware of the increasing risk of major BDI with delaying TSLC and perform interval LC before week 16.

Cited by 7 publications

References 19 publications

Risk Factors and Predictive Models for Conversion of Laparoscopic Cholecystectomy to Open Surgery, and Surgical Quality Outcome Measures

Risk Factors and Predictive Models for Conversion of Laparoscopic Cholecystectomy to Open Surgery, and Surgical Quality Outcome Measures

Factors Associated with the Success Rate of Endoscopic Retrograde Cholangiopancreatography with Standard Technique followed by Laparoscopic Cholecystectomy in the Management of Choledocholithiasis: A Single-Center Experience

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

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