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

Abstract

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. A prospective cohort of 104 patients undergoing emergency laparoscopic cholecystectomy was stratified into two groups using a serum total bilirubin of above 50μmol/L (2.9mg/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. 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 6.51days, 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. 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.