The impact of timing of cholecystectomy following gallstone pancreatitis

Johnstone, Marianne; Marriott, Paul; Royle, T. J.; Richardson, Caroline; Torrance, Andrew W.; Hepburn, Elizabeth; Bhangu, Aneel; Patel, Abhilasha; Bartlett, David; Pinkney, Thomas

doi:10.1016/j.surge.2013.07.006

Cited by 50 publications

(32 citation statements)

References 26 publications

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“…An early retrospective cohort study exploring the impact of timing of cholecystectomy after gallstone pancreatitis was been published by our group [33], and several systematic reviews have been undertaken [34-36]. The rapid emergence of parallel general surgical research groups across the UK led to the formation of the National Surgical Research Collaborative, an umbrella network whose first project was a national prospective snapshot audit of appendicectomy outcomes.…”

Section: Discussionmentioning

confidence: 99%

How to set up and manage a trainee-led research collaborative

et al. 2014

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BackgroundEnsuring that doctors in training acquire sufficient knowledge, experience and understanding of medical research is a universal and longstanding issue which has been brought into sharper focus by the growth of evidence based medicine. All healthcare systems preparing doctors in training for practice have to balance the acquisition of specific clinical attitudes, knowledge and skills with the wider need to ensure doctors are equipped to remain professionally competent as medical science advances. Most professional medical bodies acknowledge that this requires trainee doctors to experience some form of research education, not only in order to carry out original research, but to acquire sufficient academic skills to become accomplished research consumers in order to remain informed throughout their professional practice. There are many barriers to accomplishing this ambitious aim.DiscussionThis article briefly explains why research collaboratives are necessary, describes how to establish a collaborative, and recommends how to run one. It is based on the experiences of the pioneering West Midlands Research Collaborative and draws on the wider literature about the organisation and delivery of high quality research projects. Practical examples of collaborative projects are given to illustrate the potential of this form of research organisation.SummaryThe new trainee-led research collaboratives provide a supportive framework for planning, ownership and delivery of high quality multicentre research. This ensures clinical relevance, increases the chances of research findings being translated into changes in practice and should lead to improved patient outcomes. Research collaboratives also enhance the research skills and extend the scientific horizons of doctors in training.

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Section: Discussionmentioning

confidence: 99%

How to set up and manage a trainee-led research collaborative

et al. 2014

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“…Timing of interval cholecystectomy varies among studies and it has been reported that patients with severe biliary pancreatitis underwent interval cholecystectomy within 6 mo[48]. In a multicenter study including 523 patients with biliary pancreatitis, fewer operative complications during cholecystectomy were observed between 4 and 7 wk after discharge, and higher at index admission up to 2 wk after discharge[55]. Since delaying surgery further than 2 wk after discharge has no apparent unfavorable effect, and delaying definitive management after 12 wk has no prominent advantage, definitive management within 3 mo of admission may decrease recurrent biliary events, readmission rates and operative risk[55].…”

Section: Outcomes After Different Management Plansmentioning

confidence: 99%

Management of patients after recovering from acute severe biliary pancreatitis

Dedemadi

Nikolopoulos

Kalaitzopoulos

et al. 2016

WJG

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Cholelithiasis is the most common cause of acute pancreatitis, accounting 35%-60% of cases. Around 15%-20% of patients suffer a severe attack with high morbidity and mortality rates. As far as treatment is concerned, the optimum method of late management of patients with severe acute biliary pancreatitis is still contentious and the main question is over the correct timing of every intervention. Patients after recovering from an acute episode of severe biliary pancreatitis can be offered alternative options in their management, including cholecystectomy, endoscopic retrograde cholangiopancreatography (ERCP) and sphincterotomy, or no definitive treatment. Delaying cholecystectomy until after resolution of the inflammatory process, usually not earlier than 6 wk after onset of acute pancreatitis, seems to be a safe policy. ERCP and sphincterotomy on index admission prevent recurrent episodes of pancreatitis until cholecystectomy is performed, but if used for definitive treatment, they can be a valuable tool for patients unfit for surgery. Some patients who survive severe biliary pancreatitis may develop pseudocysts or walled-off necrosis. Management of pseudocysts with minimally invasive techniques, if not therapeutic, can be used as a bridge to definitive operative treatment, which includes delayed cholecystectomy and concurrent pseudocyst drainage in some patients. A management algorithm has been developed for patients surviving severe biliary pancreatitis according to the currently published data in the literature.

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“…Neither did any of these patient require intra-operative cholangiography as the preoperative MRCP had shown a clear CBD. The use of ERCP in patients with gallstone pancreatitis with jaundice has been reported to be of 29% by Johnstone et al and 17% by Falor et al 9,10 In the present study ERCP was needed only in 1 patient (2.17%) with preoperatively diagnosed CBD stone on MRCP. Surprisingly this patient had no jaundice (serum bilirubin less than 1.5).…”

Section: Discussionmentioning

confidence: 46%

“…Recurrent biliary symptoms/pancreatitis has been reported in patients who were waiting for delayed cholecystectomy at a rate of 13% by Nebiker et al, 11% by Johnstone et al and 17% by Al-Qahtani. [10][11][12] On the other hand, proponents of delayed cholecystectomy argue that if an early cholecystectomy is undertaken then patient may have a future need of repeat surgery due to late complications of pancreatitis such as pseudocyst or infective pancreatic collection. In this study future need for additional procedure was seen in only one patient (2.7%), who required a percutaneous drainage procedure for infected peri-pancreatic collection.…”

Section: Discussionmentioning

confidence: 99%

Study of laparoscopic cholecystectomy in gallstones induced pancreatitis

Bisht

Rehmani

2018

Int Surg J

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Background: Many general surgeons still harbor a notion that laparoscopic cholecystectomy in patients with acute gallstone induced pancreatitis has a higher morbidity. The timing of cholecystectomy in these patients is a matter of debate. Aim of the study was to assess the degree of difficulty, the timing of laparoscopic cholecystectomy (LC), and the complications of surgery in patients of gall stone pancreatitis subjected to laparoscopic cholecystectomy.Methods: 69 patients were diagnosed with gall stone induced pancreatitis over a period of 12 months and 46 underwent laparoscopic cholecystectomy. After an acute attack of pancreatitis the procedure was performed on index admission or was delayed for an interval of 3 to 4 weeks, thereby dividing the study sample into two on the basis of timing of surgery. The severity of pancreatitis was graded according to the Revised Atlanta criteria.Results: All the patients who underwent laparoscopic cholecystectomy had either mild or moderate severity of pancreatitis. Comparing the two groups with regard to timing of cholecystectomy, no statistically signiﬁcant difference was noted in operating time, difficulty in surgery, conversion rate to open procedure or post-operative stay.Conclusions: Laparoscopic cholecystectomy in patients with gallstone induced pancreatitis does not attribute any additional risk and does not have increased morbidity nor is there any increase risk of conversion.

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The impact of timing of cholecystectomy following gallstone pancreatitis

Cited by 50 publications

References 26 publications

How to set up and manage a trainee-led research collaborative

How to set up and manage a trainee-led research collaborative

Management of patients after recovering from acute severe biliary pancreatitis

Study of laparoscopic cholecystectomy in gallstones induced pancreatitis

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