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. DISCUSSION: A laparoscopic cholecystectomy after ES is lengthier and more difficult than in uncomplicated cholelithiasis and should therefore be performed by an experienced surgeon.
Subject(s)
Cholangiopancreatography, Endoscopic Retrograde/adverse effects , Cholecystectomy, Laparoscopic/adverse effects , Cholecystolithiasis/surgery , Choledocholithiasis/surgery , Adult , Chi-Square Distribution , Cholangiopancreatography, Endoscopic Retrograde/mortality , Cholecystectomy, Laparoscopic/mortality , Cholecystolithiasis/mortality , Choledocholithiasis/mortality , Female , Hospital Mortality , Humans , Length of Stay , Linear Models , Logistic Models , Male , Middle Aged , Multivariate Analysis , Odds Ratio , Postoperative Complications/etiology , Prospective Studies , Risk Factors , Sphincterotomy, Endoscopic/adverse effects , Time Factors , Treatment OutcomeABSTRACT
BACKGROUND: The aim of this study was to evaluate the impact of surgical subspecialization on the outcome of laparoscopic cholecystectomy. METHODS: The retrospective cohort study included all consecutive patients who underwent laparoscopic cholecystectomy between June 2002 and June 2009 in a major teaching hospital. Patients were divided into two groups: those operated on by laparoscopy-oriented surgeons (more than 50 laparoscopic procedures annually) and those operated on by nonlaparoscopy surgeons. Surgeries were divided into two groups as well: elective surgery for cholelithiasis and emergency surgery for acute cholecystitis. Conversion rate, operating time, complications, and length of hospital stay were analyzed and compared between both groups. RESULTS: During the study period 1509 patients underwent laparoscopic cholecystectomy for symptomatic gallstone disease. A laparoscopic surgeon performed the procedure on 893 patients, and 616 patients were operated on by nonlaparoscopy surgeons. For elective surgeries the laparoscopic interest of the surgeon had no influence on the outcome of the procedure. In patients with acute cholecystitis, a significant difference in conversion rate (3.6 vs. 15.6%, p = 0.003) and operating time (68 vs. 76 min, p = 0.02) favored the laparoscopic surgeons. CONCLUSIONS: Patients who present with acute cholecystitis have a greater chance of a laparoscopically completed cholecystectomy if operated on by a laparoscopy-oriented surgeon.
