Laparoscopic cholecystectomy (LC) after an endoscopic retrograde cholangiography (ERC) has higher rates for complications and conversion caused by unpredictable adhesions. The risk factors for an adverse outcome of LC after an ERC were analyzed.
MethodsVariables from patients treated by LC after ERC for cholelithiasis in two clinics from 1996 to 2003 were retrospectively stored in a database. Complications and conversions were recorded.
ResultsA total of 140 patients underwent LC after ERC (83 from clinic A and 57 from clinic B), 31% (44/140) of whom were men. Peri- or postoperative complications occurred for 28 patients (20%). For 19 patients (14%), a conversion was necessary. Significant variables associated with complications and conversions were an elevated level of C-reactive protein (CRP) at the time of LC (odds ratio [OR], 10.2; 95% confidence interval [CI], 1.1–91, P = 0.037 for both) and severe adhesions during laparoscopy (OR, 3.6; 95% CI, 1.5–8.6; P = 0.003 and OR, 5.2; 95% CI, 1.9–14.4; P = 0.002, respectively). Male gender (OR, 2.8; 95% CI, 1.1–7.6; P = 0.037) and serum bilirubin level at the time of ERC (OR, 3.7; 95% CI, 1.24–11; P = 0.014) were associated with conversion only. Time after ERC (LC within 1 week vs. >1 week or ≤2 weeks vs. 2–6 weeks vs. >6 weeks or ≤6 weeks vs. >6 weeks) was not associated with complications or conversion. Multivariate regression analysis showed a pre-LC CRP exceeding 6 to be predictive of complications (OR, 10.5; 95% CI, 1.1–95; P = 0.040) and conversion (OR, 10.6; 95% CI, 1.1–99; P = 0.034).
ConclusionMale gender, bilirubin levels during ERC, severe adhesions during LC, and pre-LC CRP levels were associated with an adverse outcome for an LC after endoscopic cholangiography. The time between LC and ERC failed to be a significant risk factor in this larger series.
This is a preview of subscription content, log in via an institution to check access.
Access this article Subscribe and saveSpringer+ Basic
€34.99 /Month
Price includes VAT (Germany)
Instant access to the full article PDF.
Similar content being viewed by others Explore related subjectsDiscover the latest articles and news from researchers in related subjects, suggested using machine learning. ReferencesCervantes J, Rojas G (2001) Choledocholithiasis: new approach to an old problem. World J Surg 25:1270–1272
Chang KK, Mo LR, Yau MP, Lin RC, Kuo JY, Tsai CC (1996) Endoscopic sphincterotomy prior to laparoscopic cholecystectomy for the treatment of cholelithiasis. Hepatogastroenterology 43:203–206
Sarli L, Iusco DR, Roncoroni L (2003) Preoperative endoscopic sphincterotomy and laparoscopic cholecystectomy for the management of cholecystocholedocholithiasis: 10-year experience. World J Surg 27:180–186
Soetikno RM, Montes H, Carr-Locke DL (1998) Endoscopic management of choledocholithiasis. J Clin Gastroenterol 27:296–305
Boerma D, Rauws EA, Keulemans YC, Janssen IM, Bolwerk CJ, Timmer R, Boerma EJ, Obertop H, Huibregtse K, Gouma DJ (2002) Wait-and-see policy or laparoscopic cholecystectomy after endoscopic sphincterotomy for bile-duct stones: a randomised trial. Lancet 360:761–765
Allen NL, Leeth RR, Finan KR, Tishler DS, Vickers SM, Wilcox CM, Hawn MT (2006) Outcomes of cholecystectomy after endoscopic sphincterotomy for choledocholithiasis. J Gastrointest Surg 10:292–296
Prat F, Malak NA, Pelletier G, Buffet C, Fritsch J, Choury AD et al (1996) Biliary symptoms and complications more than 8 years after endoscopic sphincterotomy for choledocholithiasis. Gastroenterology 110:894–899
De Vries A, Donkervoort SC, van Geloven AA, Pierik EG (2005) Conversion rate of laparoscopic cholecystectomy after endoscopic retrograde cholangiography in the treatment of choledocholithiasis: does the time interval matter? Surg Endosc 19:996–1001
Neoptolemos JP, Shaw DE, Carr-Locke DL (1989) A multivariate analysis of preoperative risk factors in patients with common bile duct stones: implications for treatment. Ann Surg 209(2):157–161
Isogai M, Yamaguchi A, Harada T, Kaneoka Y, Suzuki M (2002) Cholangitis score: a scoring system to predict severe cholangitis in gallstone pancreatitis. J Hepatobiliary Pancreat Surg 9:98–104
Eldar S, Sabo E, Nash E, Abrahamson J, Matter I (1998) Laparoscopic cholecystectomy for the various types of gallbladder inflammation: a prospective trial. Surg Laparosc Endosc 8:200–207
Brodsky A, Matter I, Sabo E, Cohen A, Abrahamson J, Eldar S (2000) Laparoscopic cholecystectomy for acute cholecystitis: can the need for conversion and the probability of complications be predicted? A prospective study. Surg Endosc 14:755–760
Alponat A, Kum CK, Koh BC, Rajnakova A, Goh PMY, Mouiel J (1997) Predictive factors for conversions of laparoscopic cholecystectomy. World J Surg 21:629–633
Liu CL, Fan ST, Lai EC, Lo CM, Chu KM (1996) Factors affecting conversion of laparoscopic cholecystectomy to open surgery. Arch Surg 131:98–101
Wiebke EA, Pruitt AL, Howard TJ, Jacobson LE, Broadie TA, Goulet RJ Jr, Canal DF (1996) Conversion of laparoscopic to open cholecystectomy: an analysis of risk factors. Surg Endosc 10:742–745
Russell JC, Walsh SJ, Reed-Fourquet L, Mattie A, Lynch J (1998) Symptomatic cholelithiasis: a different disease in men? Connecticut Laparoscopic Cholesystectomy Registry. Ann Surg 227:195–200
Yol S, Kartal A, Vatansev C, Aksoy F, Toy H (2006) Sex as a factor in conversion from laparoscopic cholecystectomy to open surgery. JSLS 10:359–363
Kama NA, Kologlu M, Doganay M, Reis E, Atli M, Dolapci M (2001) A risk score for conversion from laparoscopic to open cholecystectomy. Am J Surg 181:520–525
Schrenk P, Woisetschlager R, Wayand WU (1995) Laparoscopic cholecystectomy: cause of conversion in 1, 300 patients and analysis of risk factors. Surg Endosc 9:25–28
Lee HK, Han HS, Min SK, Lee JH (2005) Sex-based analysis of the outcome of laparoscopic cholecystectomy for acute cholecystitis. Br J Surg 92(4):463–466
Kauvar DS, Brown BD, Braswell AW, Harnisch M (2005) Laparoscopic cholecystectomy in the elderly: increased operative complications and conversions to laparoscopy. J Laparoendosc Adv Surg Tech A 15:379–382
Brunt LM, Quasebarth MA, Dunnegan DL, Soper NJ (2001) Outcomes analysis of laparoscopic cholecystectomy in the extremely elderly. Surg Endosc 15:700–705
Department of Surgery, Onze Lieve Vrouwe Gasthuis, Postbus 95500, 1090, Amsterdam, HM, The Netherlands
S. C. Donkervoort
Department of Surgery, Academical Medical Centre, Amsterdam, The Netherlands
O. van Ruler
Teaching Hospital, Onze Lieve Vrouwe Gasthuis, Postbus 95500, 1090, Amsterdam, HM, The Netherlands
L. M. Dijksman
Department of Surgery, Tergooiziekenhuizen, Hilversum, The Netherlands
A. A. van Geloven
Department of Surgery, Isala Klinieken, Zwolle, The Netherlands
E. G. Pierik
Correspondence to S. C. Donkervoort.
About this article Cite this articleDonkervoort, S.C., van Ruler, O., Dijksman, L.M. et al. Identification of risk factors for an unfavorable laparoscopic cholecystectomy course after endoscopic retrograde cholangiography in the treatment of choledocholithiasis. Surg Endosc 24, 798–804 (2010). https://doi.org/10.1007/s00464-009-0659-0
Received: 10 March 2009
Accepted: 09 July 2009
Published: 26 August 2009
Issue Date: April 2010
DOI: https://doi.org/10.1007/s00464-009-0659-0
RetroSearch is an open source project built by @garambo | Open a GitHub Issue
Search and Browse the WWW like it's 1997 | Search results from DuckDuckGo
HTML:
3.2
| Encoding:
UTF-8
| Version:
0.7.4