title: Optimal timing of elective laparoscopic cholecystectomy after acute cholangitis and subsequent clearance of choledocholithiasis.
abstract: BACKGROUND
  Elective laparoscopic cholecystectomy is recommended after endoscopic clearance of choledocholithiasis for patients with acute cholangitis, according to Tokyo guidelines. However, the optimal timing remains uncertain.
  
  
  METHODS
  Perioperative outcomes were retrospectively reviewed and compared between patients with early (< 6 weeks) and late (> 6 weeks) surgeries, while risk factors for postoperative complications were assessed using multivariate analysis.
  
  
  RESULTS
  One hundred twelve patients (mean age, 64 years; range, 30-85 years) were analyzed. Rate of conversion and intraoperative and postoperative complications (classified per Dindo et al) were 21.4% (24 of 112), 23.2% (26 of 112), and 34.8% (39 of 112), respectively. The late surgery group had significantly more intraoperative (28.8% vs 9.4%, P = .029) and postoperative (42.5% vs 15.6%, P = .007) complications compared with the early surgery group. Multivariate analysis showed both late surgery (95% confidence interval, 1.47-12.5; P = .008) and a history of endoscopic sphincterotomy (95% confidence interval, 1.06-8.26; P = .038) to be independent risk factors for postoperative complications.
  
  
  CONCLUSIONS
  Patients with endoscopic clearance of choledocholithiasis, especially after endoscopic sphincterotomy, should receive elective laparoscopic cholecystectomy within 6 weeks after a cholangitic attack.
authors.affiliation: Department of Surgery, Kwong Wah Hospital, Hong Kong, China. he3979hk@yahoo.com.hk
authors.forename: Vicky Ka Ming
authors.initials: VK
authors.lastname: Li
authors.forename: Jonathan Lau Kai
authors.initials: JL
authors.lastname: Yum
authors.forename: Yuk Pang
authors.initials: YP
authors.lastname: Yeung
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002760:Cholangiopancreatography, Endoscopic Retrograde; D049448:Cholangiopancreatography, Magnetic Resonance; D002761:Cholangitis / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D042883:Choledocholithiasis / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D003937:Diagnosis, Differential; D017558:Elective Surgical Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome