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Medline ® Abstract for Reference 30

of 'Endoscopic management of bile duct stones: Standard techniques and mechanical lithotripsy'

Early laparoscopic cholecystectomy improves outcomes after endoscopic sphincterotomy for choledochocystolithiasis.
Reinders JS, Goud A, Timmer R, Kruyt PM, Kruijt PM, Witteman BJ, Smakman N, Breumelhof R, Donkervoort SC, Jansen JM, Heisterkamp J, Grubben M, Grobben M, van Ramshorst B, Boerma D
Gastroenterology. 2010;138(7):2315.
BACKGROUND& AIMS: Patients with choledochocystolithiasis generally undergo endoscopic sphincterotomy (ES) followed by laparoscopic cholecystectomy (LC). However, many patients receive this surgery 6-8 weeks after ES. There is a high conversion rate of elective LC after ES, and patients can develop recurrent biliary events during the waiting period. We investigated whether the timing of surgery influences outcome.
METHODS: We performed a randomized trial of patients with choledochocystolithiasis who underwent successful ES. Patients were randomly assigned to groups that received early LC (within 72 hours after ES, n = 49) or delayed LC (after 6-8 weeks, n = 47), based on an expected difference in conversion rate of 25% vs 5%, respectively. Conversion rate, biliary events during follow-up, duration and difficulty of surgeries, postoperative morbidity, and hospital stay were scored. Intention-to-treat analyses were performed.
RESULTS: Groups were comparable in age, sex, and comorbidity. Therewas no difference between groups in conversion rate (4.3% in early vs 8.7% in delayed group) nor were there differences in operating times and/or difficulties or hospital stays. During the waiting period for LC, 17 patients in the delayed group (36.2%) developed recurrent biliary events compared with 1 patient in the early group (P<.001).
CONCLUSIONS: In a randomized trial to evaluate timing of LC after ES, recurrent biliary events occurred in 36.2% of patients whose LC was delayed for 6-8 weeks. Early LC (within 72 hours) appears to be safe and might prevent the majority of biliary events in this period following sphincterotomy.
Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands.