Advertisement

Impact of Jaundice on Outcomes Following Emergency Laparoscopic Cholecystectomy in Patients with Choledocholithiasis

  • Benjamin R. Poh
  • Paul A. Cashin
  • Daniel G. Croagh
Original Scientific Report

Abstract

Introduction

Traditional teaching dictates that it may not be prudent to take the jaundiced patient to theatre for emergency laparoscopic cholecystectomy as they may experience worse outcomes following surgery.

Methods

A prospective cohort of 104 patients undergoing emergency laparoscopic cholecystectomy was stratified into two groups using a serum total bilirubin of above 50 μmol/L (2.9 mg/dL) to define the jaundiced group. Primary outcomes were morbidity and mortality rate. The Clavien–Dindo classification and the novel Comprehensive Complication Index (CCI) were applied to the grading of surgical complications. Multivariate analysis to identify possible predictors of morbidity and length of stay was also performed.

Results

Overall morbidity rate in the jaundiced group was 28 versus 36% (control), p = 0.405. Mean CCI in the jaundiced group was 5.28 versus 8.00 in the control group, p = 0.229. Mean length of stay was shorter in the jaundiced group, 4.65 versus 6.51 days, p = 0.036. There were no peri-operative mortalities or conversions to open surgery. Only male gender and the presence of retained stones were found to be associated with morbidity. Serum total bilirubin was not associated with increased morbidity.

Conclusion

Amongst patients undergoing laparoscopic cholecystectomy who are found to have choledocholithiasis on IOC, the presence of jaundice does not appear to contribute towards increased morbidity.

Notes

Compliance with ethical standards

Conflict of interest

The authors have no conflicts of interest to disclose.

References

  1. 1.
    Williams EJ, Green J, Beckingham I, Parks R, Martin D, Lombard M (2008) British Society of Gastroenterology: guidelines on the management of common bile duct stones (CBDS). Gut 57:1004–1021CrossRefPubMedGoogle Scholar
  2. 2.
    Yang M-H, Chen T-H, Wang S-E, Tsai Y-F, Su C-H, Wu C-W, Lui W-Y, Shyr Y-M (2008) Biochemical predictors for absence of common bile duct stones in patients undergoing laparoscopic cholecystectomy. Surg Endosc 22:1620–1624CrossRefPubMedGoogle Scholar
  3. 3.
    Overby DW, Apelgren KN, Richardson W, Fanelli R (2010) SAGES guidelines for the clinical application of laparoscopic biliary tract surgery. Surg Endosc 24:2368–2386CrossRefPubMedGoogle Scholar
  4. 4.
    ASGE Standards of Practice Committee, Maple JT, Ben-Menachem T, Anderson MA, Appalaneni V, Banerjee S, Cash BD, Fisher L, Harrison ME, Fanelli RD, Fukami N, Ikenberry SO, Jain R, Khan K, Krinsky ML, Strohmeyer L, Dominitz JA (2010) The role of endoscopy in the evaluation of suspected choledocholithiasis. Gastrointest Endosc 71:1–9CrossRefGoogle Scholar
  5. 5.
    Lai EC, Tam PC, Paterson IA, Ng MM, Fan ST, Choi TK, Wong J (1990) Emergency surgery for severe acute cholangitis. The high-risk patients. Ann Surg 211:55–59CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Kharbutli B, Velanovich V (2008) Management of preoperatively suspected choledocholithiasis: a decision analysis. J Gastrointest Surg 12:1973–1980CrossRefPubMedGoogle Scholar
  7. 7.
    Jovanović P, Salkić NN, Zerem E, Ljuca F (2011) Biochemical and ultrasound parameters may help predict the need for therapeutic endoscopic retrograde cholangiopancreatography (ERCP) in patients with a firm clinical and biochemical suspicion for choledocholithiasis. Eur J Intern Med 22:e110–e114CrossRefPubMedGoogle Scholar
  8. 8.
    Kama NA, Doganay M, Dolapci M, Reis E, Atli M, Kologlu M (2001) Risk factors resulting in conversion of laparoscopic cholecystectomy to open surgery. Surg Endosc 15:965–968.  https://doi.org/10.1007/s00464-001-0008-4 CrossRefPubMedGoogle Scholar
  9. 9.
    Eldar S, Sabo E, Nash E, Abrahamson J, Matter I (1998) Laparoscopic cholecystectomy for the various types of gallbladder inflammation: a prospective trial. Surg Laparosc Endosc 8:200–207CrossRefPubMedGoogle Scholar
  10. 10.
    Brodsky A, Matter I, Sabo E, Cohen A, Abrahamson J, Eldar S (2000) Laparoscopic cholecystectomy for acute cholecystitis: can the need for conversion and the probability of complications be predicted? Surg Endosc 14:755–760CrossRefPubMedGoogle Scholar
  11. 11.
    Donkervoort SC, Ruler O, Dijksman LM, Geloven AA, Pierik EG (2009) Identification of risk factors for an unfavorable laparoscopic cholecystectomy course after endoscopic retrograde cholangiography in the treatment of choledocholithiasis. Surg Endosc 24:798–804CrossRefPubMedGoogle Scholar
  12. 12.
    Noble H, Whitley E, Norton S, Thompson M (2011) A study of preoperative factors associated with a poor outcome following laparoscopic bile duct exploration. Surg Endosc 25:130–139CrossRefPubMedGoogle Scholar
  13. 13.
    Poh BR, Ho SPS, Sritharan M, Yeong CC, Swan MP, Devonshire DA, Cashin PA, Croagh DG (2016) Randomized clinical trial of intraoperative endoscopic retrograde cholangiopancreatography versuslaparoscopic bile duct exploration in patients with choledocholithiasis. Br J Surg 103:1117–1124CrossRefPubMedGoogle Scholar
  14. 14.
    Yokoe M, Takada T, Strasberg SM, Solomkin JS, Mayumi T, Gomi H, Pitt HA, Garden OJ, Kiriyama S, Hata J, Gabata T, Yoshida M, Miura F, Okamoto K, Tsuyuguchi T, Itoi T, Yamashita Y, Dervenis C, Chan ACW, Lau WY, Supe AN, Belli G, Hilvano SC, Liau K-H, Kim M-H, Kim S-W, Ker C-G (2013) TG13 diagnostic criteria and severity grading of acute cholecystitis (with videos). J Hepato-Biliary-Pancreat Sci 20:35–46CrossRefGoogle Scholar
  15. 15.
    Kiriyama S, Takada T, Strasberg SM, Solomkin JS, Mayumi T, Pitt HA, Gouma DJ, Garden OJ, Büchler MW, Yokoe M, Kimura Y, Tsuyuguchi T, Itoi T, Yoshida M, Miura F, Yamashita Y, Okamoto K, Gabata T, Hata J, Higuchi R, Windsor JA, Bornman PC, Fan S-T, Singh H, de Santibanes E, Gomi H, Kusachi S, Murata A, Chen X-P, Jagannath P, Lee SG, Padbury R, Chen M-F, Dervenis C, Chan ACW, Supe AN, Liau K-H, Kim M-H, Kim S-W (2013) TG13 guidelines for diagnosis and severity grading of acute cholangitis (with videos). J Hepato-Biliary-Pancreat Sci 20:24–34CrossRefGoogle Scholar
  16. 16.
    Banks PA, Bollen TL, Dervenis C, Gooszen HG, Johnson CD, Sarr MG, Tsiotos GG, Vege SS (2012) Acute Pancreatitis Classification Working Group: Classification of acute pancreatitis—2012: revision of the Atlanta classification and definitions by international consensus. Gut 62:102–111CrossRefPubMedGoogle Scholar
  17. 17.
    Dindo D, Demartines N, Clavien P-A (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Slankamenac K, Graf R, Barkun J, Puhan MA, Clavien P-A (2013) The comprehensive complication index: a novel continuous scale to measure surgical morbidity. Ann Surg 258:1–7CrossRefPubMedGoogle Scholar
  19. 19.
    Slankamenac K, Nederlof N, Pessaux P, de Jonge J, Wijnhoven BPL, Breitenstein S, Oberkofler CE, Graf R, Puhan MA, Clavien P-A (2014) The comprehensive complication index: a novel and more sensitive endpoint for assessing outcome and reducing sample size in randomized controlled trials. Ann Surg 260:757–762 (discussion 762–3) CrossRefPubMedGoogle Scholar
  20. 20.
    Pavlidis ET, Pavlidis TE (2018) Pathophysiological consequences of obstructive jaundice and perioperative management. Hepatobiliary Pancreat Dis Int 17(1):17–21.  https://doi.org/10.1016/j.hbpd.2018.01.008 Epub 2018 Jan 31 CrossRefPubMedGoogle Scholar
  21. 21.
    Noble H, Whitley E, Norton S, Thompson M (2010) A study of preoperative factors associated with a poor outcome following laparoscopic bile duct exploration. Surg Endosc 25:130–139CrossRefPubMedGoogle Scholar
  22. 22.
    Miura F, Takada T, Strasberg SM, Solomkin JS, Pitt HA, Gouma DJ, Garden OJ, Büchler MW, Yoshida M, Mayumi T, Okamoto K, Gomi H, Kusachi S, Kiriyama S, Yokoe M, Kimura Y, Higuchi R, Yamashita Y, Windsor JA, Tsuyuguchi T, Gabata T, Itoi T, Hata J, Liau K-H (2013) TG13 flowchart for the management of acute cholangitis and cholecystitis. J Hepato-Biliary-Pancreat Sci 20:47–54CrossRefGoogle Scholar
  23. 23.
    Okamoto K, Takada T, Strasberg SM, Solomkin JS, Pitt HA, Garden OJ, Büchler MW, Yoshida M, Miura F, Kimura Y, Higuchi R, Yamashita Y, Mayumi T, Gomi H, Kusachi S, Kiriyama S, Yokoe M, Lau WY, Kim M-H (2013) TG13 management bundles for acute cholangitis and cholecystitis. J Hepato-Biliary-Pancreat Sci 20:55–59CrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2018

Authors and Affiliations

  • Benjamin R. Poh
    • 1
  • Paul A. Cashin
    • 1
    • 2
  • Daniel G. Croagh
    • 1
    • 2
  1. 1.Upper GI/HPB Surgery UnitMonash HealthClaytonAustralia
  2. 2.Department of Surgery, School of Clinical Sciences, Monash HealthMonash UniversityMelbourneAustralia

Personalised recommendations