Timing of elective laparoscopic cholecystectomy after endoscopic retrograde cholangiopancreaticography with sphincterotomy: a prospective observational study of 308 patients
Purpose Endoscopic retrograde cholangiopancreaticography (ERCP) with sphincterotomy is associated with higher rates of conversion to open surgery during subsequent laparoscopic cholecystectomy (LC). The mechanisms of this association are unclear. The aim of this study was to investigate whether the...
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| Veröffentlicht in: | Langenbeck's archives of surgery 2010-08, Vol.395 (6), p.661-666 |
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| creator | Bostanci, Erdal Birol Ercan, Metin Ozer, Ilter Teke, Zafer Parlak, Erkan Akoglu, Musa |
| description | Purpose
Endoscopic retrograde cholangiopancreaticography (ERCP) with sphincterotomy is associated with higher rates of conversion to open surgery during subsequent laparoscopic cholecystectomy (LC). The mechanisms of this association are unclear. The aim of this study was to investigate whether the time interval between the two procedures can affect the course of LC in terms of conversion rate or complications.
Methods
In this prospective observational study, 308 consecutive patients underwent ERCP with sphincterotomy followed at various intervals by elective LC. According to these intervals, the patients' data were assigned to one of three groups: short-interval (2 days or less), medium-interval (3–42 days), or long-interval (43 days or more). Groups were also defined in terms of whether gallstones were extracted during ERCP and in terms of the number of ERCPs performed (single or multiple) prior to LC. The main outcome measures for all groups were the frequency of complications during or after LC and the frequency of conversions to open surgery.
Results
Of the 308 patients, 43 required conversion to open cholecystectomy (14%). The short-interval (95 patients), medium-interval (100 patients), and long-interval (113 patients) groups did not differ significantly in terms of intraoperative complications, postoperative complications, or conversion to open surgery (
p
= 0.985, 0.340, and 0.472, respectively). The conversion rate also did not differ significantly according to the presence or absence of gallstones on ERCP (14.7% versus 12.8%, respectively,
p
= 0.392). However, compared with patients who underwent single ERCP (
n
= 290), those who underwent multiple ERCPs (
n
= 18) experienced significantly more conversion to open surgery (
p
= 0.026).
Conclusions
The length of time between endoscopic sphincterotomy and LC did not affect the latter procedure in terms of complications or conversion to open surgery. However, the lack of an association between conversion rate and gallstone presence on ERCP and the higher conversion rate among patients who underwent multiple ERCPs, suggest that ERCP with sphincterotomy itself may be a factor in the higher conversion rates that have been observed after this procedure. |
| doi_str_mv | 10.1007/s00423-010-0653-y |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_734007229</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>734007229</sourcerecordid><originalsourceid>FETCH-LOGICAL-c343t-81effb730c7ddf720e3bfd97739c88ea3e1e85b55d2c742e0d2b13db7aeb39a23</originalsourceid><addsrcrecordid>eNp9Uctu1DAUtRCIlpYPYIO8YxW4tpNxwg5VpUWqxKZdW459M-MqiY3tFOWj-EccZtolK1v3PO7jEPKBwWcGIL8kgJqLChhUsGtEtb4i56wWTcXrhr1--dfijLxL6REAdrKr35IzDg3fSdmdkz_3bnLznvqB4ogmuyekow46-mR8cIaagy_1NeUC-mmlesgYKc72mRAxR7-P2uI_rp73zgc9m4g6O7Mh4bDS3y4faAoHN5ui95vVV6ppKH3Cqa3vE8anIvKzHmnKi123sQS0NJQqzjldkjeDHhO-P70X5OH79f3VbXX38-bH1be7yoha5KplOAy9FGCktYPkgKIfbCel6EzbohbIsG36prHcyJojWN4zYXupsRed5uKCfDr6lvl-LZiymlwyOJbt0C9JSVGX-3PeFSY7Mk3ZJEUcVIhu0nFVDNQWkjqGpEpIagtJrUXz8eS-9BPaF8VzKoXAj4RUoHmPUT36JZarpP-4_gVBT6R6</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>734007229</pqid></control><display><type>article</type><title>Timing of elective laparoscopic cholecystectomy after endoscopic retrograde cholangiopancreaticography with sphincterotomy: a prospective observational study of 308 patients</title><source>MEDLINE</source><source>SpringerLink Journals - AutoHoldings</source><creator>Bostanci, Erdal Birol ; Ercan, Metin ; Ozer, Ilter ; Teke, Zafer ; Parlak, Erkan ; Akoglu, Musa</creator><creatorcontrib>Bostanci, Erdal Birol ; Ercan, Metin ; Ozer, Ilter ; Teke, Zafer ; Parlak, Erkan ; Akoglu, Musa</creatorcontrib><description>Purpose
Endoscopic retrograde cholangiopancreaticography (ERCP) with sphincterotomy is associated with higher rates of conversion to open surgery during subsequent laparoscopic cholecystectomy (LC). The mechanisms of this association are unclear. The aim of this study was to investigate whether the time interval between the two procedures can affect the course of LC in terms of conversion rate or complications.
Methods
In this prospective observational study, 308 consecutive patients underwent ERCP with sphincterotomy followed at various intervals by elective LC. According to these intervals, the patients' data were assigned to one of three groups: short-interval (2 days or less), medium-interval (3–42 days), or long-interval (43 days or more). Groups were also defined in terms of whether gallstones were extracted during ERCP and in terms of the number of ERCPs performed (single or multiple) prior to LC. The main outcome measures for all groups were the frequency of complications during or after LC and the frequency of conversions to open surgery.
Results
Of the 308 patients, 43 required conversion to open cholecystectomy (14%). The short-interval (95 patients), medium-interval (100 patients), and long-interval (113 patients) groups did not differ significantly in terms of intraoperative complications, postoperative complications, or conversion to open surgery (
p
= 0.985, 0.340, and 0.472, respectively). The conversion rate also did not differ significantly according to the presence or absence of gallstones on ERCP (14.7% versus 12.8%, respectively,
p
= 0.392). However, compared with patients who underwent single ERCP (
n
= 290), those who underwent multiple ERCPs (
n
= 18) experienced significantly more conversion to open surgery (
p
= 0.026).
Conclusions
The length of time between endoscopic sphincterotomy and LC did not affect the latter procedure in terms of complications or conversion to open surgery. However, the lack of an association between conversion rate and gallstone presence on ERCP and the higher conversion rate among patients who underwent multiple ERCPs, suggest that ERCP with sphincterotomy itself may be a factor in the higher conversion rates that have been observed after this procedure.</description><identifier>ISSN: 1435-2443</identifier><identifier>EISSN: 1435-2451</identifier><identifier>DOI: 10.1007/s00423-010-0653-y</identifier><identifier>PMID: 20526779</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer-Verlag</publisher><subject>Abdominal Surgery ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Cardiac Surgery ; Cholangiopancreatography, Endoscopic Retrograde ; Cholecystectomy, Laparoscopic ; Elective Surgical Procedures ; Female ; Gallstones - surgery ; Gallstones - therapy ; General Surgery ; Humans ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Original Article ; Prospective Studies ; Sphincterotomy, Endoscopic ; Thoracic Surgery ; Time Factors ; Traumatic Surgery ; Vascular Surgery ; Young Adult</subject><ispartof>Langenbeck's archives of surgery, 2010-08, Vol.395 (6), p.661-666</ispartof><rights>Springer-Verlag 2010</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c343t-81effb730c7ddf720e3bfd97739c88ea3e1e85b55d2c742e0d2b13db7aeb39a23</citedby><cites>FETCH-LOGICAL-c343t-81effb730c7ddf720e3bfd97739c88ea3e1e85b55d2c742e0d2b13db7aeb39a23</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00423-010-0653-y$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00423-010-0653-y$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>315,781,785,27929,27930,41493,42562,51324</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/20526779$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Bostanci, Erdal Birol</creatorcontrib><creatorcontrib>Ercan, Metin</creatorcontrib><creatorcontrib>Ozer, Ilter</creatorcontrib><creatorcontrib>Teke, Zafer</creatorcontrib><creatorcontrib>Parlak, Erkan</creatorcontrib><creatorcontrib>Akoglu, Musa</creatorcontrib><title>Timing of elective laparoscopic cholecystectomy after endoscopic retrograde cholangiopancreaticography with sphincterotomy: a prospective observational study of 308 patients</title><title>Langenbeck's archives of surgery</title><addtitle>Langenbecks Arch Surg</addtitle><addtitle>Langenbecks Arch Surg</addtitle><description>Purpose
Endoscopic retrograde cholangiopancreaticography (ERCP) with sphincterotomy is associated with higher rates of conversion to open surgery during subsequent laparoscopic cholecystectomy (LC). The mechanisms of this association are unclear. The aim of this study was to investigate whether the time interval between the two procedures can affect the course of LC in terms of conversion rate or complications.
Methods
In this prospective observational study, 308 consecutive patients underwent ERCP with sphincterotomy followed at various intervals by elective LC. According to these intervals, the patients' data were assigned to one of three groups: short-interval (2 days or less), medium-interval (3–42 days), or long-interval (43 days or more). Groups were also defined in terms of whether gallstones were extracted during ERCP and in terms of the number of ERCPs performed (single or multiple) prior to LC. The main outcome measures for all groups were the frequency of complications during or after LC and the frequency of conversions to open surgery.
Results
Of the 308 patients, 43 required conversion to open cholecystectomy (14%). The short-interval (95 patients), medium-interval (100 patients), and long-interval (113 patients) groups did not differ significantly in terms of intraoperative complications, postoperative complications, or conversion to open surgery (
p
= 0.985, 0.340, and 0.472, respectively). The conversion rate also did not differ significantly according to the presence or absence of gallstones on ERCP (14.7% versus 12.8%, respectively,
p
= 0.392). However, compared with patients who underwent single ERCP (
n
= 290), those who underwent multiple ERCPs (
n
= 18) experienced significantly more conversion to open surgery (
p
= 0.026).
Conclusions
The length of time between endoscopic sphincterotomy and LC did not affect the latter procedure in terms of complications or conversion to open surgery. However, the lack of an association between conversion rate and gallstone presence on ERCP and the higher conversion rate among patients who underwent multiple ERCPs, suggest that ERCP with sphincterotomy itself may be a factor in the higher conversion rates that have been observed after this procedure.</description><subject>Abdominal Surgery</subject><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Cardiac Surgery</subject><subject>Cholangiopancreatography, Endoscopic Retrograde</subject><subject>Cholecystectomy, Laparoscopic</subject><subject>Elective Surgical Procedures</subject><subject>Female</subject><subject>Gallstones - surgery</subject><subject>Gallstones - therapy</subject><subject>General Surgery</subject><subject>Humans</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Original Article</subject><subject>Prospective Studies</subject><subject>Sphincterotomy, Endoscopic</subject><subject>Thoracic Surgery</subject><subject>Time Factors</subject><subject>Traumatic Surgery</subject><subject>Vascular Surgery</subject><subject>Young Adult</subject><issn>1435-2443</issn><issn>1435-2451</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2010</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9Uctu1DAUtRCIlpYPYIO8YxW4tpNxwg5VpUWqxKZdW459M-MqiY3tFOWj-EccZtolK1v3PO7jEPKBwWcGIL8kgJqLChhUsGtEtb4i56wWTcXrhr1--dfijLxL6REAdrKr35IzDg3fSdmdkz_3bnLznvqB4ogmuyekow46-mR8cIaagy_1NeUC-mmlesgYKc72mRAxR7-P2uI_rp73zgc9m4g6O7Mh4bDS3y4faAoHN5ui95vVV6ppKH3Cqa3vE8anIvKzHmnKi123sQS0NJQqzjldkjeDHhO-P70X5OH79f3VbXX38-bH1be7yoha5KplOAy9FGCktYPkgKIfbCel6EzbohbIsG36prHcyJojWN4zYXupsRed5uKCfDr6lvl-LZiymlwyOJbt0C9JSVGX-3PeFSY7Mk3ZJEUcVIhu0nFVDNQWkjqGpEpIagtJrUXz8eS-9BPaF8VzKoXAj4RUoHmPUT36JZarpP-4_gVBT6R6</recordid><startdate>20100801</startdate><enddate>20100801</enddate><creator>Bostanci, Erdal Birol</creator><creator>Ercan, Metin</creator><creator>Ozer, Ilter</creator><creator>Teke, Zafer</creator><creator>Parlak, Erkan</creator><creator>Akoglu, Musa</creator><general>Springer-Verlag</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20100801</creationdate><title>Timing of elective laparoscopic cholecystectomy after endoscopic retrograde cholangiopancreaticography with sphincterotomy: a prospective observational study of 308 patients</title><author>Bostanci, Erdal Birol ; Ercan, Metin ; Ozer, Ilter ; Teke, Zafer ; Parlak, Erkan ; Akoglu, Musa</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c343t-81effb730c7ddf720e3bfd97739c88ea3e1e85b55d2c742e0d2b13db7aeb39a23</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2010</creationdate><topic>Abdominal Surgery</topic><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Cardiac Surgery</topic><topic>Cholangiopancreatography, Endoscopic Retrograde</topic><topic>Cholecystectomy, Laparoscopic</topic><topic>Elective Surgical Procedures</topic><topic>Female</topic><topic>Gallstones - surgery</topic><topic>Gallstones - therapy</topic><topic>General Surgery</topic><topic>Humans</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Original Article</topic><topic>Prospective Studies</topic><topic>Sphincterotomy, Endoscopic</topic><topic>Thoracic Surgery</topic><topic>Time Factors</topic><topic>Traumatic Surgery</topic><topic>Vascular Surgery</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Bostanci, Erdal Birol</creatorcontrib><creatorcontrib>Ercan, Metin</creatorcontrib><creatorcontrib>Ozer, Ilter</creatorcontrib><creatorcontrib>Teke, Zafer</creatorcontrib><creatorcontrib>Parlak, Erkan</creatorcontrib><creatorcontrib>Akoglu, Musa</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Langenbeck's archives of surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Bostanci, Erdal Birol</au><au>Ercan, Metin</au><au>Ozer, Ilter</au><au>Teke, Zafer</au><au>Parlak, Erkan</au><au>Akoglu, Musa</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Timing of elective laparoscopic cholecystectomy after endoscopic retrograde cholangiopancreaticography with sphincterotomy: a prospective observational study of 308 patients</atitle><jtitle>Langenbeck's archives of surgery</jtitle><stitle>Langenbecks Arch Surg</stitle><addtitle>Langenbecks Arch Surg</addtitle><date>2010-08-01</date><risdate>2010</risdate><volume>395</volume><issue>6</issue><spage>661</spage><epage>666</epage><pages>661-666</pages><issn>1435-2443</issn><eissn>1435-2451</eissn><abstract>Purpose
Endoscopic retrograde cholangiopancreaticography (ERCP) with sphincterotomy is associated with higher rates of conversion to open surgery during subsequent laparoscopic cholecystectomy (LC). The mechanisms of this association are unclear. The aim of this study was to investigate whether the time interval between the two procedures can affect the course of LC in terms of conversion rate or complications.
Methods
In this prospective observational study, 308 consecutive patients underwent ERCP with sphincterotomy followed at various intervals by elective LC. According to these intervals, the patients' data were assigned to one of three groups: short-interval (2 days or less), medium-interval (3–42 days), or long-interval (43 days or more). Groups were also defined in terms of whether gallstones were extracted during ERCP and in terms of the number of ERCPs performed (single or multiple) prior to LC. The main outcome measures for all groups were the frequency of complications during or after LC and the frequency of conversions to open surgery.
Results
Of the 308 patients, 43 required conversion to open cholecystectomy (14%). The short-interval (95 patients), medium-interval (100 patients), and long-interval (113 patients) groups did not differ significantly in terms of intraoperative complications, postoperative complications, or conversion to open surgery (
p
= 0.985, 0.340, and 0.472, respectively). The conversion rate also did not differ significantly according to the presence or absence of gallstones on ERCP (14.7% versus 12.8%, respectively,
p
= 0.392). However, compared with patients who underwent single ERCP (
n
= 290), those who underwent multiple ERCPs (
n
= 18) experienced significantly more conversion to open surgery (
p
= 0.026).
Conclusions
The length of time between endoscopic sphincterotomy and LC did not affect the latter procedure in terms of complications or conversion to open surgery. However, the lack of an association between conversion rate and gallstone presence on ERCP and the higher conversion rate among patients who underwent multiple ERCPs, suggest that ERCP with sphincterotomy itself may be a factor in the higher conversion rates that have been observed after this procedure.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer-Verlag</pub><pmid>20526779</pmid><doi>10.1007/s00423-010-0653-y</doi><tpages>6</tpages></addata></record> |
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| subjects | Abdominal Surgery Adolescent Adult Aged Aged, 80 and over Cardiac Surgery Cholangiopancreatography, Endoscopic Retrograde Cholecystectomy, Laparoscopic Elective Surgical Procedures Female Gallstones - surgery Gallstones - therapy General Surgery Humans Male Medicine Medicine & Public Health Middle Aged Original Article Prospective Studies Sphincterotomy, Endoscopic Thoracic Surgery Time Factors Traumatic Surgery Vascular Surgery Young Adult |
| title | Timing of elective laparoscopic cholecystectomy after endoscopic retrograde cholangiopancreaticography with sphincterotomy: a prospective observational study of 308 patients |
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