Outcomes of 11,276 patients undergoing open versus laparoscopic cholecystoenterostomy for biliary enteric bypass: a retrospective population based study (NIS 1998 - 2014)

Presenter: Sushruta S Nagarkatti MD | Ascension Providence Hospital Background: The first cholecystoenterostomy (CCE) was performed as far back as 1880 in a patient with a distal common bile duct obstruction and a distended gallbladder. The procedure, has however, received criticism due to its evaluation in small retrospective or prospective series. Our aim was to perform a population based study to determine the demographic, clinical and peri-operative outcomes of this procedure, both laparoscopic and open. Methods: National Inpatient Database (NIS 1998 - 2014) was used to identify patients who received CCE (ICD-9 51.32). ICD 9 code 54.21 was used to identify patients who received laparoscopic assisted CCE. Discharge weights were applied to get national estimates. Demographic, clinical and outcomes data was compared using standard statistical methodology. Results: 11,276 patients received CCE during the study period, of whom 10,990 (97.5%) received open and 287 (2.5%) received laparoscopic approach. The mean age was 64.6 years and operative approach did not differ between them. The most common indication for performing a CCE was carcinoma of the pancreas (N=7707, 68.3%) followed by a common bile duct (CBD) stricture (N=428, 3.8%), ampullary carcinoma (N=214, 1.9%), and with chronic pancreatitis (N=197, 1.7%). The all-cause peri-operative mortality rate was 6.5% with an overall morbidity of 20.2%. Binary logistic regression identified, respiratory [OR 5.5, Confidence Interval; CI (4.2-7.2)], cardiac [OR 2.4 (CI; 1.6-3.7)], and urinary [OR 3.5 (CI; 2.2-5.5)] complications were independently associated with increased mortality (p<0.001). Conclusion: Majority of patients received CCE by open approach, and pancreatic cancer was the most common indication for this palliative procedure. Post-operative respiratory, cardiac and urinary complications are associated with higher mortality. Further studies are warranted to validate findings of this study and develop therapeutic guidelines.