With CD Stone Risk, Shorter Stays w/Cholecystectomy First
Second study shows outcomes no worse with lack of post-op antibiotics after cholecystectomy
TUESDAY, July 8, 2014 (HealthDay News) -- For patients at intermediate risk of a common duct stone, initial cholecystectomy without preoperative endoscopic investigation reduces length of stay. In addition, lack of postoperative antibiotic treatment is not associated with worse outcomes after cholecystectomy. These findings were published in the July 9 issue of the Journal of the American Medical Association.
Pouya Iranmanesh, M.D., from the Geneva University Hospital, and colleagues conducted a randomized trial involving patients at intermediate risk of a common duct stone to compare strategies of cholecystectomy first versus a sequential endoscopic common duct assessment and cholecystectomy. The researchers found that the median length of stay was significantly shorter for patients who underwent initial cholecystectomy (median, five versus eight days), with fewer common duct investigations and no significant difference in morbidity or quality of life.
Jean Marc Regimbeau, M.D., Ph.D., from the Amiens University Medical Center in France, and colleagues examined the effect of postoperative amoxicillin plus clavulanic acid on infection rates in 414 patients with mild or moderate calculous cholecystitis receiving pre- and intraoperative antibiotics who underwent cholecystectomy. The researchers found that the postoperative infection rate was 17 percent in the nontreatment group compared with 15 percent in the infection group in the imputed intention-to-treat analysis. The corresponding rates in the per-protocol analysis involving 338 patients were both 13 percent. The lack of postoperative antibiotic treatment was not associated with worse outcomes based on a noninferiority margin of 11 percent.
"[These clinical trials] provide useful data that help answer important questions about the management of patients undergoing cholecystectomy," writes the author of an accompanying editorial.