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

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.

Immediate versus Delayed Laparoscopic Cholecystectomy after Endoscopic Retrograde Cholangiopancreatography in Choledocholithiasis

“…Our study demonstrated statistically significant differences in length of hospital stays (LOS) between the groups was 0.9 versus 1.95 days for immediate LC group & delayed LC group respectively. This finding agrees with Tracy et al (15) who concluded that performing a cholecystectomy right away significantly shortened recovery time after surgery. Also, Kent et al (8) revealed that group 1 (immediate LC) had a significantly shorter hospital length of stay (2 ±1 day's vs 3 ± 2 days), P ≤0.001).…”

Retracted Article: Rendezvous procedure for choledocholithiasis in a Canadian rural surgical service

“…7 Interhospital transfers and delays in surgery have been shown to increase patient morbidity, rates of conversion to an open procedure and hospital length of stay. 1 , 8 , 9 …”

“…7 Interhospital transfers and delays in surgery have been shown to increase patient morbidity, rates of conversion to an open pro cedure and hospital length of stay. 1,8,9 What resources are needed to perform the rendezvous procedure in a rural hospital?…”

“…Choledocholithiasis is typically managed in 2 stages: an endoscopic retrograde cholangiopancreatography (ERCP) followed, days or weeks later, by a laparoscopic cholecystectomy (LC). 1 , 2 Given the substantial travel burden and loss to follow-up experienced by patients with choledocholithiasis, surgeons at the Sioux Lookout Meno Ya Win Health Centre (SLMHC) in northwest Ontario have adopted a 1-stage approach: the rendezvous procedure. This provides treatment in 1 hospital admission with a single anesthetic, so that patients receive high-quality treatment closer to home.…”

Patients with Primary and Secondary Bile Duct Stones Harbor Distinct Biliary Microbial Composition and Metabolic Potential

“…Cholelithiasis including gallbladder stone and bile duct stone has a prevalence rate of nearly 10% among adults ( Tracy et al., 2021 ). In clinical practice, patients with bile duct stone can develop cholangitis due to bile duct obstruction and infection, which occurs frequently in emergencies ( Williams et al., 2017 ).…”