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Late two‐stage laparoscopic cholecystectomy is associated with an increased risk of major bile duct injury
Author(s) -
Beliaev Andrei M.,
Booth Michael
Publication year - 2015
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/ans.12967
Subject(s) - medicine , endoscopic retrograde cholangiopancreatography , confidence interval , bile duct , cholecystectomy , surgery , retrospective cohort study , laparoscopic cholecystectomy , dissection (medical) , stage (stratigraphy) , common bile duct , pancreatitis , paleontology , biology
Background Late laparoscopic cholecystectomy ( LC ) after endoscopic retrograde cholangiopancreatography ( ERCP ) and sphincterotomy ( ES ) for common bile duct ( CBD ) stone clearance, two‐stage LC ( TSLC ), is associated with difficult surgical dissection and an increased rate of conversion to open procedure. The purpose of the study was to evaluate whether the interval between ERCP / ES and LC is associated with major bile duct injury ( BDI ) and determine an optimal period for TSLC . Methods This was a retrospective cohort study of adult patients who underwent LC . The exclusion criteria were absence of CBD stones on imaging or ERCP , surgical treatment of choledocholithiasis, post‐operative endoscopic CBD stone clearance and open cholecystectomy. Results The eligibility criteria were met by 183 patients. There were six major BDIs (3%). Comparisons of the early and late TSLC showed statistically significant difference in major BDI at 16‐week cut‐offs. Binomial regression analysis demonstrated that late (≥16 weeks) TSLC was associated with 10‐fold increase in major BDI (95% confidence interval: 1.1–95.7, P = 0.043). Survival analysis comparing early (<16 weeks) with late (≥16 weeks) TSLC demonstrated that both groups had similar survival time (log‐rank test: 0.317). Conclusion General surgeons should be aware of the increasing risk of major BDI with delaying TSLC and perform interval LC before week 16.