Background: Cholecystectomy after gallstone pancreatitis may be technically demanding. The aim of this study was to investigate risk factors for a difficult cholecystectomy after mild pancreatitis. Methods: This was a prospective study within a randomized controlled trial on the timing of cholecystectomy after mild gallstone pancreatitis. Difficulty of cholecystectomy was scored on a 0 to 10 visual analogue scale (VAS) by the senior attending surgeon. The primary outcome ‘difficult cholecystectomy’ was defined by presence of one or more of the following features: a VAS score ≥ 8, duration of surgery > 75 minutes, conversion or subtotal cholecystectomy. Results: 249 patients were included in the primary analysis. A difficult cholecystectomy occurred in 82 patients (33%). In the ‘same-admission cholecystectomy’ group 29 of 112 cholecystectomies were difficult (26%) versus 49 of 127 patients (39%) who underwent surgery after 2 weeks (p = 0.037). After multivariable analysis, male sex (OR 1.80, 95% confidence interval [CI] 1.04−3.13; p = 0.037), prior sphincterotomy (OR 1.79, 95% CI 1.01−3.16; p = 0.046), and delaying cholecystectomy for at least two weeks (OR 1.81, 95% CI 1.04−3.16; p = 0.036) were independent predictors of a difficult cholecystectomy. Conclusion: Surgeons should anticipate a difficult cholecystectomy after mild gallstone pancreatitis in case of male sex, prior sphincterotomy and delayed cholecystectomy.

Additional Metadata
Persistent URL,
Journal HPB
Rights no subscription
Da Costa, D.W, Schepers, N.J, Bouwense, S.A.W, Hollemans, R.A. (Robbert A.), van Santvoort, H.C, Bollen, T.L, … Besselink, M.G. (2018). Predicting a ‘difficult cholecystectomy’ after mild gallstone pancreatitis. HPB. doi:10.1016/j.hpb.2018.10.015