Early Laparoscopic Cholecystectomy for Mild Gallstone Pancreatitis

Abstract

Hypothesis: Patients with mild gallstone pancreatitis may undergo an early laparoscopic cholecystectomy (LC) within 48 hours of hospital admission without awaiting the normalization of pancreatic and liver enzyme levels. This may decrease the hospital stay without increasing morbidity or mortality and may minimize the unnecessary use of endoscopic retrograde cholangiopancreatography. Design: A retrospective review. Setting: Two university-affiliated urban medical centers. Patients: A total of 303 patients with mild gallstone pancreatitis, of whom 117 underwent an early LC and 186 underwent a delayed LC. Main Outcome Measures: Hospital length of stay, morbidity and mortality rates, and the use of endoscopic retrograde cholangiopancreatography. Results: Similar hospital admission variables were observed in the early and delayed LC groups, although the delayed group was older (P =.006). The median hospital length of stay was significantly less for the early group than for the delayed group (3 vs 6 days; PϽ .001). There were no patients who died, and the complication rates were similar for both groups. However, the patients who underwent an early LC were less likely than patients who underwent a delayed LC to undergo endoscopic retrograde cholangiopancreatography (P =.02). Conclusions: An early LC may be safely performed for patients with mild gallstone pancreatitis, without concern for increased morbidity and mortality, resulting in shortened hospital stays and a decrease in the use of endoscopic retrograde cholangiopancreatography. The practice of delaying an LC until normalization of laboratory values appears to be unnecessary.

Early Versus Delayed Laparoscopic Cholecystectomy for Acute Cholecystitis: A Prospective, Randomized Study

“…In the past, the optimal timing for laparoscopic cholecystectomy for patients with acute cholecystitis had generally been considered to be 6 to 8 eight weeks after the acute phase to allow for resolution of the acute inflammation of the gallbladder. 8 However, several clinical trials-albeit mostly small and retrospective studies-proved that early laparoscopic cholecystectomy is safe and shortens hospital stay, with morbidity and mortality similar to those of elective delayed cholecystectomy. 2,4,8,9,11 In a retrospective analysis of 100 patients, Ohta et al 11 compared 4 timing groups of laparoscopic cholecystectomy (72 hours, 4-14 days, 3-6 weeks, and .6 weeks after onset of symptoms) and found that the best timing for laparoscopic cholecystectomy for acute cholecystitis is within 72 hours, which provides the shortest total hospital stay versus operations performed later.…”

“…8 However, several clinical trials-albeit mostly small and retrospective studies-proved that early laparoscopic cholecystectomy is safe and shortens hospital stay, with morbidity and mortality similar to those of elective delayed cholecystectomy. 2,4,8,9,11 In a retrospective analysis of 100 patients, Ohta et al 11 compared 4 timing groups of laparoscopic cholecystectomy (72 hours, 4-14 days, 3-6 weeks, and .6 weeks after onset of symptoms) and found that the best timing for laparoscopic cholecystectomy for acute cholecystitis is within 72 hours, which provides the shortest total hospital stay versus operations performed later. Falor et al 8 performed early laparoscopic cholecystectomy (within 48 hours of admission) in 117 of 303 patients with mild gallstone pancreatitis; for the rest of the patients, operation was delayed until the normalization of laboratory values.…”

“…2 However, early laparoscopic cholecystectomy is still performed by only a minority of surgeons. [7][8][9] Furthermore, the exact timing, potential benefits, and cost-effectiveness of laparoscopic cholecystectomy in the treatment of acutely inflamed gallbladder have not been clearly established and continue to be controversial. 1,10 The aim of this study was to compare the intraoperative and postoperative outcomes, and cost of early versus delayed laparoscopic cholecystectomy for acute cholecystitis.…”

Early laparoscopic cholecystectomy in acute cholecystitis: safety and advantages

“…9 As the experience and confidence of surgeons in laparoscopic cholecystectomy rose up, several clinical trials, though samples were small in size, proved that early laparoscopic cholecystectomy in acute cholecystitis is feasible, safe, cheaper and requires shorter hospitalization.…”

“…7 However, till now only a minority of surgeons is performing early laparoscopic cholecystectomy. [8][9][10] As this procedure demands a huge experience in laparoscopic cholecystectomy, the number of surgeons performing early laparoscopic cholecystectomy for acute cholecystitis in India is very small owing to late introduction of procedure in our country. Till now, the exact timing and potential benefits of early laparoscopic removal of gall bladder have not been clearly established and continue to be controversial.…”