Early laparoscopic cholecystectomy improves outcomes after endoscopic sphincterotomy for choledochocystolithiasis.
OBJECTIVE
Patients with choledochocystolithiasis generally undergo endoscopic sphincterotomy (ES) followed by laparoscopic cholecystectomy (LC). However, many patients receive this surgery 6-8 weeks after ES. There is a high conversion rate of elective LC after ES, and patients can develop recurrent biliary events during the waiting period. We investigated whether the timing of surgery influences outcome.


METHODS
We performed a randomized trial of patients with choledochocystolithiasis who underwent successful ES. Patients were randomly assigned to groups that received early LC (within 72 hours after ES, n = 49) or delayed LC (after 6-8 weeks, n = 47), based on an expected difference in conversion rate of 25% vs 5%, respectively. Conversion rate, biliary events during follow-up, duration and difficulty of surgeries, postoperative morbidity, and hospital stay were scored. Intention-to-treat analyses were performed.


RESULTS
Groups were comparable in age, sex, and comorbidity. There was no difference between groups in conversion rate (4.3% in early vs 8.7% in delayed group) nor were there differences in operating times and/or difficulties or hospital stays. During the waiting period for LC, 17 patients in the delayed group (36.2%) developed recurrent biliary events compared with 1 patient in the early group (P < .001).


CONCLUSIONS
In a randomized trial to evaluate timing of LC after ES, recurrent biliary events occurred in 36.2% of patients whose LC was delayed for 6-8 weeks. Early LC (within 72 hours) appears to be safe and might prevent the majority of biliary events in this period following sphincterotomy.
Reinders
Jan Siert K
JS
Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands.
Goud
Annemarie
A
Timmer
Robin
R
Kruyt
Philip M
PM
Kruijt
Philip M
PM
Witteman
Ben J M
BJ
Smakman
Niels
N
Breumelhof
Ronald
R
Donkervoort
Sandra C
SC
Jansen
Jeroen M
JM
Heisterkamp
Joos
J
Grubben
Marina
M
Grobben
Marina
M
van Ramshorst
Bert
B
Boerma
Djamila
D
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D042883:Choledocholithiasis / Q000601:surgery*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D016717:Sphincterotomy, Endoscopic / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome