Background: According to the literature, the conversion
rate for laparoscopic cholecystectomy (LC) after endoscopic
sphincterotomy (ES) for cholecystodocholithiasis
reaches 20%, at least when LC is performed 6 to 8 weeks
afterward. It is hypothesized that early planned LC after ES
prevents recurrent biliary complications and reduces
operative morbidity and hospital stay.
Methods: All consecutive patients who underwent LC
after ES between 2001 and 2004 were retrospectively
evaluated. Recurrent biliary complications during the
waiting time for LC, conversion rate, postoperative complications,
and hospital stay were documented.
Results: This study analyzed 167 consecutive patients (59
men) with a median age of 54 years. The median interval
between ES and LC was 7 weeks (range, 1β49 weeks).
During the waiting time for LC, 33 patients (20%) had
recurrent biliary complications including cholecystitis
(n = 18, 11%), recurrent choledocholithiasis (n = 9, 5%),
cholangitis (n = 4, 2%), and biliary pancreatitis (n = 2,
1%). Of these 33 patients, 15 underwent a second endoscopic
retrograde cholangiography (ERC). The median
time between ES and the development of recurrent complications
was 22 days (range, 3β225 days). Most of the
biliary complications (76%) occurred more than 1 week
after ES. Conversion to open cholecystectomy occurred for
7 of 33 patients with recurrent complications during the
waiting period, compared with 13 of 134 patients with an
uncomplicated waiting period (p = 0.14). This concurred
with doubled postoperative morbidity (24% vs 11%;
p = 0.09) and a longer hospital stay (median, 4 vs 2 days;
p < 0.001).
Conclusion: In this retrospective analysis, 20% of all
patients had recurrent biliary complications during the
waiting period for cholecystectomy after ES. These
recurrent complications were associated with a significantly
longer hospital stay. Cholecystectomy within 1 week
after ES may prevent recurrent biliary complications in the
majority of cases and reduce the postoperative hospital
stay
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