Early laparoscopic cholecystectomy in acute biliary pancreatitis: the optimal choice?

Abstract

The optimal time for managing cholelithiasis in acute biliary pancreatitis (ABP) is still controversial. One hundred and nineteen consecutive patients of ABP were taken up for the study after grouping them according to Glasgow modification of Ranson's criteria. Twelve patients with severe acute pancreatitis were excluded from the study. Laparoscopic cholecystectomy (LC) was carried out during the same admission in 81 patients, while 26 patients opted for interval LC after six weeks. The results were analysed in terms of difficult dissection, operating time, complications and discharge time. The parameters of the patients undergoing early laparoscopic cholecystectomy (ELC) were then compared with those undergoing interval LC and 90 control patients who underwent elective LC for cholelithiasis. There was no difference in the operative parameters among the three groups except that dissection was significantly more difficult in patients being operated after six weeks of the attack. Also in those being operated immediately after the attack, significantly greater number of patients required a fourth port for completion of surgery as compared to the control patients. ELC in patients with mild acute biliary pancreatitis appears to be a viable and better alternative to interval cholecystectomy.

Implementation of an Acute Care Surgery Service Facilitates Modern Clinical Practice Guidelines for Gallstone Pancreatitis

“…However, evidence supporting the validity of the aforementioned factors is lacking. Index cholecystectomy can be cost-neutral and the dissection of the gallbladder may even be easier in the setting of gallstone pancreatitis (37,38). These suggestions are supported by our data, which found index surgery resulted in significantly fewer ER visits, hospital re-admissions, as well as shorter OR times and no difference in conversion to open surgery.…”

SAGES guidelines for the clinical application of laparoscopic biliary tract surgery

“…There is agreement that severe pancreatitis with ongoing multisystem organ failure requires immediate clearing of any biliary obstruction, usually with ERCP, followed by supportive care until the patient recovers sufficiently to tolerate cholecystectomy [127]. However, when pancreatitis caused by gallstones is mild and [96,[126][127][128][129][130][131][132][133], while others delay cholecystectomy for weeks; decision-making algorithms regarding approaches to pre-versus intraoperative common bile duct evaluation and clearance are even more provider dependent, though patients with mild pancreatitis generally do not benefit from preoperative ERCP [126,134].…”

Early laparoscopic cholecystectomy following acute biliary pancreatitis expedites recovery

“…In contrast, Sinha [19] proposed that dissection difficulties are encountered more in late cholecystectomies than in early cholecystectomies.…”