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Cholecystectomy after ERCP in elderly patients led to longer hospital stays, more complications
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Patients aged 80 years and older who underwent cholecystectomy after endoscopic retrograde cholangiopancreatography had longer hospital stays and were at greater risk for postoperative complications, according to data presented at the Society of American Gastrointestinal and Endoscopic Surgeons Annual Meeting in Baltimore.
In a retrospective analysis, researchers evaluated data from 68 patients (mean age, 85 years) with common bile duct (CBD) stones who received endoscopic retrograde cholangiopancreatography (ERCP) between February 2007 and December 2008. The cohort included three patients who already had undergone cholecystectomy upon ERCP and five who later had the procedure.
All cholecystectomy recipients experienced postoperative complications, and stayed in hospitals for a mean of 14 days. Acute renal failure occurred in two open cholecystectomy recipients, with other complications including two lower respiratory tract infections, one urinary tract infection, one case of biliary stricture and sepsis and one intra-abdominal collection.
Among patients who did not undergo cholecystectomy after ERCP, three patients died of cholangitis during their initial admission. Eleven participants re-presented during follow-up, including four for CBD stones, one for CBD stricture and two each for cholangitis, cholecystitis and biliary colic. Nine patients died during follow-up for reasons unrelated to gallstones.
“Surgery in [patients in their 80s] is associated with greater length of hospital stay and incidence of postoperative complications,” the researchers concluded. “In patients who do not have symptoms of gallstone disease, nonoperative management of CBD stones post-ERCP and sphincterotomy is a safe alternative.”
For more information:
Teasdale RL. S039: Cholecystectomy After ERCP in the Over 80s: Adding Insult to Injury? Presented at: the Society of American Gastrointestinal and Endoscopic Surgeons 2013 Annual Meeting; April 17-20, Baltimore.