Cholecystectomy or gallbladder in situ after endoscopic sphincterotomy and bile duct stone removal in Chinese patients.
OBJECTIVE
In patients with stones in their bile ducts and gallbladders, cholecystectomy is generally recommended after endoscopic sphincterotomy and clearance of bile duct stones. However, only approximately 10% of patients with gallbladders left in situ will return with further biliary complications. Expectant management is alternately advocated. In this study, we compared the treatment strategies of laparoscopic cholecystectomy and gallbladders left in situ.


METHODS
We randomized patients (>60 years of age) after endoscopic sphincterotomy and clearance of their bile duct stones to receive early laparoscopic cholecystectomy or expectant management. The primary outcome was further biliary complications. Other outcome measures included adverse events after cholecystectomy and late deaths from all causes.


RESULTS
One hundred seventy-eight patients entered into the trial (89 in each group); 82 of 89 patients who were randomized to receive laparoscopic cholecystectomy underwent the procedure. Conversion to open surgery was needed in 16 of 82 patients (20%). Postoperative complications occurred in 8 patients (9%). Analysis was by intention to treat. With a median follow-up of approximately 5 years, 6 patients (7%) in the cholecystectomy group returned with further biliary events (cholangitis, n = 5; biliary pain, n = 1). Among those with gallbladders in situ, 21 (24%) returned with further biliary events (cholangitis, n = 13; acute cholecystitis, n = 5; biliary pain, n = 2; and jaundice, n = 1; log rank, P = .001). Late deaths were similar between groups (cholecystectomy, n = 19; gallbladder in situ, n = 11; P = .12).


CONCLUSIONS
In the Chinese, cholecystectomy after endoscopic treatment of bile duct stones reduces recurrent biliary events and should be recommended.
Lau
James Y W
JY
Department of Surgery, Prince of Wales Hospital, the Chinese University of Hong Kong, Hong Kong SAR, China. laujyw@surgery.cuhk.edu.hk
Leow
Chon-Kar
CK
Fung
Terence M K
TM
Suen
Bing-Yee
BY
Yu
Ly-Mee
LM
Lai
Paul B S
PB
Lam
Yuk-Hoi
YH
Ng
Enders K W
EK
Lau
Wan Yee
WY
Chung
Sydney S C
SS
Sung
Joseph J Y
JJ
D000368:Aged; D000369:Aged, 80 and over; D001649:Bile Duct Diseases / Q000209:etiology / Q000601:surgery*; D002681:China; D002760:Cholangiopancreatography, Endoscopic Retrograde; D017081:Cholecystectomy, Laparoscopic; D042883:Choledocholithiasis / Q000473:pathology / Q000601:surgery*; D005260:Female; D042882:Gallstones / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007813:Laparotomy; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D016896:Treatment Outcome