Outcomes following early versus delayed cholecystectomy performed for acute cholangitis.
Acute Disease
Adult
Aged
Cholangitis
/ etiology
Cholecystectomy, Laparoscopic
/ adverse effects
Female
Hospitalization
/ statistics & numerical data
Humans
Intraoperative Complications
/ epidemiology
Male
Middle Aged
Operative Time
Postoperative Complications
/ epidemiology
Retrospective Studies
Time Factors
Time-to-Treatment
/ statistics & numerical data
Treatment Outcome
Acute cholangitis
Conversion to open cholecystectomy
Gallstones
Timing of cholecystectomy
Tokyo grade
Journal
Surgical endoscopy
ISSN: 1432-2218
Titre abrégé: Surg Endosc
Pays: Germany
ID NLM: 8806653
Informations de publication
Date de publication:
07 2020
07 2020
Historique:
received:
10
04
2019
accepted:
21
08
2019
pubmed:
5
9
2019
medline:
25
5
2021
entrez:
5
9
2019
Statut:
ppublish
Résumé
Early cholecystectomy following an episode of gallstone pancreatitis is data supported, however, there is minimal literature regarding the optimal timing for cholecystectomy following an episode of acute cholangitis. Our study aims to determine the ideal timing for laparoscopic cholecystectomy following an episode of acute cholangitis. A retrospective chart review was done on cholecystectomies performed for cholangitis at our institution from 2008 to 2015. Patients were compared based on timing of cholecystectomy (i.e., index admission versus delayed) and Tokyo severity grade (I-III). We identified 151 patients who underwent cholecystectomy for cholangitis at our institution from 2008 to 2015. Cholecystectomy was performed during the index admission for 61.6% of patients and Tokyo grade (TG) did not affect the rate of cholecystectomy during index admission (TG1 65.2%, TG2 64.1%, TG3 52.8%; p = 0.46). There was no difference in average operative time (89.0 min vs. 96.6 min; p = 0.36) or conversion to open cholecystectomy (5.4% vs. 10.3%; p = 0.34) between early and late cholecystectomy groups. There was also no statistically significant difference in intra-operative complications (9.7% vs. 15.5%; p = 0.28) or overall complication rates (16.1% vs. 29.3%; p = 0.05) based on timing of cholecystectomy; however, post-operative complications were significantly higher for the delayed cholecystectomy group (20.7% vs. 6.5%; p = 0.01). Early cholecystectomy after cholangitis is safe to perform and is not associated with higher operative times or rate of conversion to open, regardless of Tokyo grade. Due to the risk of developing recurrent cholangitis and a higher rate of post-operative complications seen with delayed cholecystectomy, our recommendation is to perform cholecystectomy during the index admission.
Sections du résumé
BACKGROUND
Early cholecystectomy following an episode of gallstone pancreatitis is data supported, however, there is minimal literature regarding the optimal timing for cholecystectomy following an episode of acute cholangitis. Our study aims to determine the ideal timing for laparoscopic cholecystectomy following an episode of acute cholangitis.
METHODS
A retrospective chart review was done on cholecystectomies performed for cholangitis at our institution from 2008 to 2015. Patients were compared based on timing of cholecystectomy (i.e., index admission versus delayed) and Tokyo severity grade (I-III).
RESULTS
We identified 151 patients who underwent cholecystectomy for cholangitis at our institution from 2008 to 2015. Cholecystectomy was performed during the index admission for 61.6% of patients and Tokyo grade (TG) did not affect the rate of cholecystectomy during index admission (TG1 65.2%, TG2 64.1%, TG3 52.8%; p = 0.46). There was no difference in average operative time (89.0 min vs. 96.6 min; p = 0.36) or conversion to open cholecystectomy (5.4% vs. 10.3%; p = 0.34) between early and late cholecystectomy groups. There was also no statistically significant difference in intra-operative complications (9.7% vs. 15.5%; p = 0.28) or overall complication rates (16.1% vs. 29.3%; p = 0.05) based on timing of cholecystectomy; however, post-operative complications were significantly higher for the delayed cholecystectomy group (20.7% vs. 6.5%; p = 0.01).
CONCLUSIONS
Early cholecystectomy after cholangitis is safe to perform and is not associated with higher operative times or rate of conversion to open, regardless of Tokyo grade. Due to the risk of developing recurrent cholangitis and a higher rate of post-operative complications seen with delayed cholecystectomy, our recommendation is to perform cholecystectomy during the index admission.
Identifiants
pubmed: 31482348
doi: 10.1007/s00464-019-07095-0
pii: 10.1007/s00464-019-07095-0
doi:
Types de publication
Comparative Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
3204-3210Références
Nagino M, Takada T, Kawarada Y, Nimura Y, Yamashita Y, Tsuyuguchi Takada T, Wada K, Mayumi T et al (2007) Methods and timing of biliary drainage for acute cholangitis: Tokyo Guidelines. J Hepatobiliary Pancreat Surg. https://doi.org/10.1007/s00534-006-1158-5
doi: 10.1007/s00534-006-1158-5
pubmed: 17909712
pmcid: 2799047
Miura F, Takada T, Kawarada Y, Nimura Y, Wada K, Hirota M, Nagino M, Tsuyuguchi T, Mayumi T, Yoshida M, Strasberg SM, Pitt HA, Belghiti J, de Santibanes E, Gadacz TR, Gouma DJ, Fan ST, Chen MF, Padbury RT et al (2007) Flowcharts for the diagnosis and treatment of acute cholangitis and cholecystitis: Tokyo guidelines. J Hepatobiliary Pancreat Surg. https://doi.org/10.1007/s00534-006-1153-x
doi: 10.1007/s00534-006-1153-x
pubmed: 17520213
pmcid: 2799047
Miura F, Okamoto K, Takada T, Strasberg SM, Asbun HJ, Pitt HA, Gomi H, Solomkin JS, Schlossberg D, Han HS, Kim MH, Hwang TL, Chen MF, Huang WSW, Kiriyama S, Itoi T, Garden OJ, Liau KH, Horiguchi A et al (2018) Tokyo guidelines 2018: initial management of acute biliary infection and flowchart for acute cholangitis. J. Hepatobiliary. Pancreat. Sci. https://doi.org/10.1002/jhbp.509
doi: 10.1002/jhbp.509
pubmed: 29130611
Poon RTP, Liu CL, Lo CM, Lam CM, Yuen WK, Yeung C, Fan ST, Wong J (2001) Management of gallstone cholangitis in the era of laparoscopic cholecystectomy. Arch Surg. https://doi.org/10.1001/archsurg.136.1.11
doi: 10.1001/archsurg.136.1.11
pubmed: 11387012
Jee SL, Jarmin R, Lim KF, Raman K (2018) Outcomes of early versus delayed cholecystectomy in patients with mild to moderate acute biliary pancreatitis: a randomized prospective study. Surg Asian J. https://doi.org/10.1016/j.asjsur.2016.07.010
doi: 10.1016/j.asjsur.2016.07.010
Li VKM, Yum JLK, Yeung YP (2010) Optimal timing of elective laparoscopic cholecystectomy after acute cholangitis and subsequent clearance of choledocholithiasis. Am J Surg. https://doi.org/10.1016/j.amjsurg.2009.11.010
doi: 10.1016/j.amjsurg.2009.11.010
pubmed: 20870205
pmcid: 2901881
Wang CC, Tsai MC, Wang Y (2019) Role of cholecystectomy in choledocolithiasis patients underwent endoscopic retrograde cholangiopancreatography. Sci Rep 9:2168
doi: 10.1038/s41598-018-38428-z
Georgiades CP, Mavromatis TN, Kourlaba GC, Kapiris SA, Bairamides EG, Spyrou AM, Kokkinos CN, Spyratou CS, Ieronymou MI, Diamantopoulos GI (2008) Is inflammation a significant predictor of bile duct injury during laparoscopic cholecystectomy? Endosc Other Interv Technol Surg. https://doi.org/10.1007/s00464-008-9943-7
doi: 10.1007/s00464-008-9943-7
Huang RJ, Barakat MT, Girotra M, Banerjee S (2017) Practice patterns for cholecystectomy after endoscopic retrograde cholangiopancreatography for patients with choledocholithiasis. Gastroenterology. https://doi.org/10.1053/j.gastro.2017.05.048
doi: 10.1053/j.gastro.2017.05.048
pubmed: 29284412
pmcid: 5581725
Rosenthal R, Hoffmann H, Clavien PA, Bucher HC, Dell-Kuster S (2015) Definition and classification of intraoperative complications (classic): Delphi study and pilot evaluation. Surg World J. https://doi.org/10.1007/s00268-015-3003-y
doi: 10.1007/s00268-015-3003-y
Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. https://doi.org/10.1097/01.sla.0000133083.54934.ae
doi: 10.1097/01.sla.0000133083.54934.ae
pubmed: 15570203
pmcid: 1356513
Abe T, Amano H, Hanada K, Bekki T, Minami T, Yonehara S, Noriyuki T, Nakahara M (2019) Efficacy and safety of early cholecystectomy for comorbid acute cholecystitis and acute cholangitis: retrospective cohort study. Med. Surg Ann. https://doi.org/10.1016/j.amsu.2018.10.031
doi: 10.1016/j.amsu.2018.10.031
Strasberg SM, Pucci MJ, Brunt LM, Deziel DJ (2016) Subtotal cholecystectomy-“enestrating” vs ‘reconstituting’ Subtypes and the prevention of bile duct injury: definition of the optimal procedure in difficult operative conditions. J Am Coll Surg. https://doi.org/10.1016/j.jamcollsurg.2015.09.019
doi: 10.1016/j.jamcollsurg.2015.09.019
pubmed: 27072308
pmcid: 5561649
Jang SE, Park SW, Lee BS, Shin CM, Lee SH, Kim JW, Jeong SH, Kim N, Lee DH, Park JK, Hwang JH (2013) Management for CBD stone-related mild to moderate acute cholangitis: urgent versus elective ERCP. Dig Dis Sci. https://doi.org/10.1007/s10620-013-2595-z
doi: 10.1007/s10620-013-2595-z
pubmed: 23912249
Kiriyama S, Takada T, Hwang TL, Akazawa K, Miura F, Gomi H, Mori R, Endo I, Itoi T, Yokoe M, Chen MF, Jan YY, Ker CG, Wang HP, Wada K, Yamaue H, Miyazaki M, Yamamoto M (2017) Clinical application and verification of the TG13 diagnostic and severity grading criteria for acute cholangitis: an international multicenter observational study. J Hepatobiliary Pancreat Sci. https://doi.org/10.1002/jhbp.458
doi: 10.1002/jhbp.458
pubmed: 29090868
Schiphorst AHW, Besselink MGH, Boerma D, Timmer R, Wiezer MJ, Van Erpecum KJ, Broeders IAMJ, Van Ramshorst B (2008) Timing of cholecystectomy after endoscopic sphincterotomy for common bile duct stones. Endosc Other Interv Technol Surg. https://doi.org/10.1007/s00464-008-9764-8
doi: 10.1007/s00464-008-9764-8