title: Laparoscopic cholecystectomy is more difficult after a previous endoscopic retrograde cholangiography.
abstract: BACKGROUND
  Endoscopic retrograde cholangiography (ERCP) with endoscopic sphincterotomy (ES) followed by a laparoscopic cholecystectomy (LC) is generally accepted as the treatment of choice for patients with choledochocystolithiasis who are eligible for surgery. Previous studies have shown that LC after ES is associated with a high conversion rate. The aim of the present study was to assess the complexity of LC after ES compared with standard LC for symptomatic uncomplicated cholecystolithiasis.
  
  
  METHODS
  The study population consisted of two patient cohorts: patients who had undergone a previous ERCP with ES for choledocholithiasis (PES) and patients with cholecystolithiasis who had no previous intervention prior to LC (NPES).
  
  
  RESULTS
  The PES group consisted of 93 patients and the NPES group consisted of 83 consecutive patients. Patients in the PES group had higher risks for longer [more than 65 min, odds ratio (OR) = 4.21 (95% confidence interval (CI) 1.79-9.91)] and more complex [higher than 6 points, on a 0-10 scale, OR 3.12 (95% CI 1.43-6.81)] surgery. The conversion rate in the PES and NPES group (6.5% versus 2.4%, respectively) and the complication rate (12.9% versus 9.6%, respectively) were not significantly different.
  
  
  CONCLUSIONS
  A laparoscopic cholecystectomy after ES is lengthier and more difficult than in uncomplicated cholelithiasis and should therefore be performed by an experienced surgeon.
authors: Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands.
authors: Jan Siert Kayitsinga
authors: JS
authors: Reinders
authors: Dirk Joan
authors: DJ
authors: Gouma
authors: Joos
authors: J
authors: Heisterkamp
authors: Ellen
authors: E
authors: Tromp
authors: Bert
authors: B
authors: van Ramshorst
authors: Djamila
authors: D
authors: Boerma
mesh_terms: D000328:Adult; D016009:Chi-Square Distribution; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects* / Q000401:mortality; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects* / Q000401:mortality; D041761:Cholecystolithiasis / Q000401:mortality / Q000601:surgery*; D042883:Choledocholithiasis / Q000401:mortality / Q000601:surgery*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D012307:Risk Factors; D016717:Sphincterotomy, Endoscopic / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome
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