title: Outcomes of cholecystectomy after endoscopic sphincterotomy for choledocholithiasis.
abstract: Laparoscopic cholecystectomy (LC) for treatment of symptomatic common bile duct stones (CBDS) after endoscopic sphincterotomy (ES) is associated with increased conversion and complications compared with other indications. We examined factors associated with conversion and complications of LC after ES. A retrospective study of 32 patients undergoing ES for CBDS followed by cholecystectomy was undertaken. Surgical outcomes for this group were compared with a control population of 499 LCs for all other indications. Factors associated with open cholecystectomy and complications in the ES group were analyzed. Patients undergoing LC preceded by ES had a significantly higher complication (odds ratio [OR] = 7.97; 95% CI, 2.84-22.5) and conversion rate (OR = 3.45; 95% CI, 1.56-7.66) compared with LC for all other indications. Pre-ES serum bilirubin greater than 5 mg/dL was predictive of conversion (positive predictive value = 63%, P < 0.005). Patients with symptomatic CBDS that undergo LC after ES have higher complication and conversion rates than patients undergoing LC without ES. Pre-ES serum bilirubin is useful in identifying patients who may not have a successful laparoscopic approach at cholecystectomy.
authors.affiliation: Department of Surgery, University of Alabama at Birmingham, KB 417 1530 3rd Avenue South, Birmingham, AL 35294, USA.
authors.forename: Nechol L
authors.initials: NL
authors.lastname: Allen
authors.forename: Ruth R
authors.initials: RR
authors.lastname: Leeth
authors.forename: Kelly R
authors.initials: KR
authors.lastname: Finan
authors.forename: Darren S
authors.initials: DS
authors.lastname: Tishler
authors.forename: Selwyn M
authors.initials: SM
authors.lastname: Vickers
authors.forename: C Mel
authors.initials: CM
authors.lastname: Wilcox
authors.forename: Mary T
authors.initials: MT
authors.lastname: Hawn
mesh_terms: D000469:Alkaline Phosphatase / Q000032:analysis; D001663:Bilirubin / Q000097:blood; D002763:Cholecystectomy / Q000379:methods; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects; D042883:Choledocholithiasis / Q000601:surgery*; D005260:Female; D006801:Humans; D007902:Length of Stay; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D016717:Sphincterotomy, Endoscopic; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000469:Alkaline Phosphatase; D001663:Bilirubin