Concomitant cholecystectomy did not significantly reduce the risk of subsequent biliary events and malignancy in...

This nationwide cohort study compared long-term subsequent benign biliary events and biliary tract malignancy in patients with gallstone ileus treated with or without concomitant cholecystectomy.

This retrospective cohort study used data from the Taiwan National Health Insurance Research Database. All patients diagnosed with gallstone ileus between 2000 and 2012 were included. Patients with a history of cholecystectomy, those of undetermined sex, and those aged < 18 years were excluded. The patients were divided into two groups based on whether they underwent concomitant cholecystectomy at the index admission. Cholecystectomy was defined using ICD-9-OP codes. The primary endpoint was re-hospitalization with a diagnosis of biliary complications and malignancy of the biliary tree. All patients were followed up until the end of 2013 for biliary complications or death.

We included 376 patients with a median follow-up of 34.23 months (0.07-169.7 months). There were no between-group differences in prior biliary events (p = 0.068) or in incident biliary events during follow-up (median time to event, 10.67 months from index admission; p = 0.056). The NC group had a notably higher proportion of patients with histories of congestive heart failure, cerebrovascular disease, peptic ulcers, malignancy, hypertension, and hyperlipidemia. The NC group had similar 30-day mortality but a significantly shorter hospital stay and lower overall cost than the CC group, and a higher proportion but not statistically significant (p = 0.056) of overall biliary complications. A history of biliary complications was a risk factor for biliary complications. Concomitant cholecystectomy did not significantly prevent biliary complications, including benign biliary events or malignancy.

Receiving concomitant cholecystectomy provided minimal benefit in reducing the long-term risk of biliary complications or malignancy. Therefore, the benefits of concomitant cholecystectomy during gallstone ileus treatment should be carefully evaluated.