Predicting a 'difficult cholecystectomy' after mild gallstone pancreatitis.

Abstract

BACKGROUND:

Cholecystectomy after gallstone pancreatitis may be technically demanding. The aim of this study was to investigate risk factors for a difficult cholecystectomy after mild pancreatitis.

METHODS:

This was a prospective study within a randomized controlled trial on the timing of cholecystectomy after mild gallstone pancreatitis. Difficulty of cholecystectomy was scored on a 0 to 10 visual analogue scale (VAS) by the senior attending surgeon. The primary outcome 'difficult cholecystectomy' was defined by presence of one or more of the following features: a VAS score ≥ 8, duration of surgery > 75 minutes, conversion or subtotal cholecystectomy.

RESULTS:

249 patients were included in the primary analysis. A difficult cholecystectomy occurred in 82 patients (33%). In the 'same-admission cholecystectomy' group 29 of 112 cholecystectomies were difficult (26%) versus 49 of 127 patients (39%) who underwent surgery after 2 weeks (p = 0.037). After multivariable analysis, male sex (OR 1.80, 95% confidence interval [CI] 1.04-3.13; p = 0.037), prior sphincterotomy (OR 1.79, 95% CI 1.01-3.16; p = 0.046), and delaying cholecystectomy for at least two weeks (OR 1.81, 95% CI 1.04-3.16; p = 0.036) were independent predictors of a difficult cholecystectomy.

CONCLUSION:

Surgeons should anticipate a difficult cholecystectomy after mild gallstone pancreatitis in case of male sex, prior sphincterotomy and delayed cholecystectomy.

• Authors: David W da Costa, Nicolien J Schepers, Stefan A Bouwense, Robbert A Hollemans, Hjalmar C van Santvoort, Thomas L Bollen, Esther C Consten, Harry van Goor, Sijbrand Hofker, Hein G Gooszen, Djamila Boerma, Marc G Besselink, Dutch Pancreatitis Study Group
• Journal: HPB : the official journal of the International Hepato Pancreato Biliary Association (HPB (Oxford)) Vol. 21 Issue 7 Pg. 827-833 (07 2019) ISSN: 1477-2574 [Electronic] England
• PMID: 30538063 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2018 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.

Topics

• Adult
• Aged
• Cholecystectomy (adverse effects)
• Female
• Gallstones (complications, diagnosis, surgery)
• Humans
• Male
• Middle Aged
• Netherlands
• Operative Time
• Pancreatitis (diagnosis, etiology)
• Postoperative Complications (etiology)
• Prospective Studies
• Risk Assessment
• Risk Factors
• Sex Factors
• Time Factors
• Time-to-Treatment
• Treatment Outcome