Early laparoscopic cholecystectomy reduces hospital stay in mild gallstone pancreatitis. A randomized controlled trial

Abstract

Background: Two strategies for same-admission cholecystectomy in mild gallstone pancreatitis (MGP) exist: early surgery (within 48-72 h from admission) and delayed surgery until resolution of symptoms and normalization of pancreatic tests.Methods: This was a single-center, open-label RCT. Patients with MGP according to revised Atlanta classification-2012 and SIRS criteria were randomly assigned to early laparoscopic cholecystectomy (E-LC) within 72 h from admission or delayed laparoscopic cholecystectomy (D-LC). Laparoscopicendoscopic rendezvous was performed when common bile duct stones were found at systematic intraoperative cholangiography. The primary outcome was length of stay (LOS), and the secondary outcomes were complications at 90 days, need for ERCP/choledocolithiasis, conversion, and readmission. One year of follow-up was carried-on.Results: At interim analysis, 52 patients were randomized (26 E-LC, 26 D-LC). E-LC versus D-LC was associated with a significantly shorter LOS (median 58 versus 167 h; P = 0.001). There were no differences in ERCP necessity for choledocolithiasis between the two approaches (E-LC 26.9% versus D-LC 23.1%, P = 1.00). No differences in postoperative complications were found.Conclusions: E-LC approach in patients with MGP significantly reduced LOS and was not associated with clinically relevant postoperative complications.Trial registration: clinicaltrials.gov (NCT02590978).

Cutting out Cholecystectomy on Index Hospitalization Leads to Increased Readmission Rates, Morbidity, Mortality and Cost

“…Several metanalysis showed interval cholecystectomy after mild biliary pancreatitis is associated with high risk of readmission for recurrent biliary events [ 4 , 5 , 6 ]. Prospective randomized studies showed that index admission laparoscopic cholecystectomy in mild to moderate acute biliary pancreatitis reduced the risk for recurrent attacks and was not linked to increased operative challenges or morbidity in the peri-operative period [ 7 , 8 , 9 , 10 ]. Hence removal of the source via cholecystectomy is important to prevent recurrence especially as recurrent attacks can be associated with worse outcomes.…”

Attenuation around the gallbladder on plain abdominal computed tomography as a predictor of surgical difficulty in laparoscopic cholecystectomy

“…4,[11][12][13][14][15][16][17][18] The superiority of early surgery was confirmed in studies of cholecystectomies after both the treatment of choledocholithiasis with endoscopic retrograde cholangiopancreatography and acute pancreatitis. [19][20][21][22][23] Consequently, surgery is recommended within 72 hours from the onset of acute cholecystitis. Abbreviations: γ-GTP, γ-glutamyl transpeptidase; ALP, alkaline phosphatase; ALT, alanine aminotransferase; AST, aspartate aminotransferase; CRP, C-reactive protein; CT, computed tomography; eGFR, estimated glomerular filtration rate; PLT, platelet count; TG, Tokyo guidelines; WBC, white blood count.…”

Colecistectomia: técnicas e suas indicações / Cholecystectomy: techniques and their indications

“…A CL reduziu as taxas de mortalidade e a permanência hospitalar pós-operatória sem aumentar os tempos operatórios e as taxas de hemorragia grave. 5,6,7 3.3 COLECISTECTOMIA LAPAROSCÓPICA A colecistectomia laparoscópica é um procedimento cirúrgico minimamente invasivo para a remoção de uma vesícula biliar afetada. Apesar de possuir as mesmas indicações da colecistectomia aberta, a técnica laparoscópica vem substituindo a técnica aberta desde a década de 90, em virtude das vantagens que a mesma apresenta.…”

“…NVPO e dor pós-operatória são comuns em pacientes após CL e influenciam diretamente na permanência hospitalar, readmissão e satisfação pós-operatória. 5,6,7…”

“…A CL reduziu as taxas de mortalidade e a permanência hospitalar pós-operatória sem aumentar os tempos operatórios e as taxas de hemorragia grave. 5,6,7…”