Outcomes following early versus delayed cholecystectomy performed for acute cholangitis.

Publication Title

Surgical endoscopy

Authors

Andrew Discolo, Department of General Surgery, Swedish Medical Center First Hill, 747 Broadway, Heath Tenth Floor, Seattle, WA, 98122-4307, USA
Shelby Reiter, Department of General Surgery, Swedish Medical Center First Hill, 747 Broadway, Heath Tenth Floor, Seattle, WA, 98122-4307, USAFollow
Bryce French, Department of General Surgery, Swedish Medical Center First Hill, 747 Broadway, Heath Tenth Floor, Seattle, WA, 98122-4307, USA
Danielle Hayes, Department of General Surgery, Swedish Medical Center First Hill, 747 Broadway, Heath Tenth Floor, Seattle, WA, 98122-4307, USAFollow
Gary Lucas, Department of General Surgery, Swedish Medical Center First Hill, 747 Broadway, Heath Tenth Floor, Seattle, WA, 98122-4307, USAFollow
Lancy Tan, Department of General Surgery, Swedish Medical Center First Hill, 747 Broadway, Heath Tenth Floor, Seattle, WA, 98122-4307, USAFollow
James Scanlan, Department of General Surgery, Swedish Medical Center First Hill, 747 Broadway, Heath Tenth Floor, Seattle, WA, 98122-4307, USAFollow
Ryan Martinez, Department of General Surgery, Swedish Medical Center First Hill, 747 Broadway, Heath Tenth Floor, Seattle, WA, 98122-4307, USAFollow

Document Type

Article

Publication Date

7-1-2020

Keywords

washington; seattle; swedish

Abstract

BACKGROUND: Early cholecystectomy following an episode of gallstone pancreatitis is data supported, however, there is minimal literature regarding the optimal timing for cholecystectomy following an episode of acute cholangitis. Our study aims to determine the ideal timing for laparoscopic cholecystectomy following an episode of acute cholangitis.

METHODS: A retrospective chart review was done on cholecystectomies performed for cholangitis at our institution from 2008 to 2015. Patients were compared based on timing of cholecystectomy (i.e., index admission versus delayed) and Tokyo severity grade (I-III).

RESULTS: We identified 151 patients who underwent cholecystectomy for cholangitis at our institution from 2008 to 2015. Cholecystectomy was performed during the index admission for 61.6% of patients and Tokyo grade (TG) did not affect the rate of cholecystectomy during index admission (TG1 65.2%, TG2 64.1%, TG3 52.8%; p = 0.46). There was no difference in average operative time (89.0 min vs. 96.6 min; p = 0.36) or conversion to open cholecystectomy (5.4% vs. 10.3%; p = 0.34) between early and late cholecystectomy groups. There was also no statistically significant difference in intra-operative complications (9.7% vs. 15.5%; p = 0.28) or overall complication rates (16.1% vs. 29.3%; p = 0.05) based on timing of cholecystectomy; however, post-operative complications were significantly higher for the delayed cholecystectomy group (20.7% vs. 6.5%; p = 0.01).

CONCLUSIONS: Early cholecystectomy after cholangitis is safe to perform and is not associated with higher operative times or rate of conversion to open, regardless of Tokyo grade. Due to the risk of developing recurrent cholangitis and a higher rate of post-operative complications seen with delayed cholecystectomy, our recommendation is to perform cholecystectomy during the index admission.

Area of Special Interest

Digestive Health

Specialty/Research Institute

Swedish Digestive Health Institute

Specialty/Research Institute

Hepatology

Specialty/Research Institute

Surgery