Andrew C Discolo, MD, Shelby Reiter, MD, Bryce French, MD, Danielle Hayes, MD, Gary Lucas, MD, Lancy Tan, Ryan Martinez, MD. Swedish Medical Center First Hill
Purpose: Early cholecystectomy following gallstone pancreatitis is data supported, however there is minimal literature regarding optimal timing for cholecystectomy following cholangitis. Our study sought to assess the ideal timing for laparoscopic cholecystectomy following an episode of acute cholangitis.
Methods: A retrospective chart review was performed on all cholecystectomies performed at our institution using CPT codes. Cases that were performed for cholangitis were identified. Patient characteristics were extracted from the medical record including age, comorbidities, length of hospitalization, laboratory values, Tokyo grade, ERCP results and operative results. Patients with a diagnosis of pancreatic or biliary cancer were excluded.
Results: We identified 4447 patients who underwent cholecystectomy at our institution from 2008 to 2015. In 119 of those patients the indication for cholecystectomy was cholangitis. Out of these 75 had Tokyo grade (TG) 1 cholangitis, 22 had TG2 and 21 had TG3. Patients with TG3 cholangitis were significantly older, had longer hospital length of stay and had more comorbidities. Cholecystectomy was performed earlier for low grade cholangitis vs. higher grade (TG1 average of 10 days after admission, TG2 24 days, TG3 47 days, p = 0.279). Placement of a cholecystostomy tube was associated with an operation performed greater than 6 weeks after admission for cholangitis (p = 0.005). Patients with TG2 and TG3 cholangitis who underwent cholecystectomy were significantly more have their surgery converted to open (TG1 0%, TG2 14%, TG3 10%, p = 0.008) though there did not appear to be a difference in average operative time (TG1 85 minutes, TG2 85 minutes, TG3 87 minutes, p = 0.955). Patients that received cholecystectomy done on the same admission had no difference in TG or post-operative complications compared to those who had a cholecystectomy done on a different admission.
Conclusions: Early cholecystectomy after cholangitis is safe to perform and is not associated with higher risk of complications. Due to the risk of developing another episode of cholangitis, our recommendation is to perform cholecystectomy during the same admission as diagnosis of cholangitis. TG2 and TG3 cholangitis carry a higher risk of conversion to an open procedure though there does not seem to be a difference in operative time.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94541
Program Number: S001
Presentation Session: Biliary
Presentation Type: Podium