Timing of Cholecystectomy for Acute Biliary Pancreatitis: Outcomes of Cholecystectomy on First Admission and after Recurrent Biliary Pancreatitis

Abstract

Biliary stones are the leading cause of acute pancreatitis. Although cholecystectomy and selective endoscopic retrograde cholangiography (ERC) comprise the current treatment in patients with acute biliary pancreatitis (ABP), the time of intervention is still controversial. In this study we evaluated the outcomes of cholecystectomy on first admission for ABP and in patients with recurrent biliary pancreatitis. A series of 43 patients with ABP between January 1997 and November 2000 were evaluated retrospectively. Patients were classified into two groups. Group I included 27 patients who underwent cholecystectomy on first admission before discharge from the hospital. Group II comprised 16 patients who had recurrent biliary pancreatitis and then underwent cholecystectomy. The severity of the pancreatitis was determined by Ranson's criteria. Age, gender, length of hospital stay, severity of pancreatitis, amylase level, and complications of cholecystectomy were evaluated in both groups. Patients in group I underwent cholecystectomy during the original hospital admission and patients in group II during an admission for a recurrence. There were 24 patients with a Ranson's score </= 3 in group I and 12 in group II. The mean hospital stays were 15.29 days (range 4-48 days) and 36.66 days (range 15-123 days) in groups I and II, respectively ( p = 0.006). Morbidity was 11% without mortality in group I and 43% with one mortality in group II ( p = 0.023). Definitive treatment of ABP can be accomplished effectively and safely by cholecystectomy following clinical improvement, with selective ERC performed during the first admission (delayed cholecystectomy). Waiting to perform cholecystectomy (interval cholecystectomy) may result in recurrent biliary pancreatitis, which may increase morbidity and the length of the hospital stay.

Timing of cholecystectomy in biliary pancreatitis treatment

“…Morbidity and recurrence rates are lower in patients who were operated during the early period (25,26). Regardless of laboratory findings and pain status, laparoscopic cholecystectomy can be safely performed in patients with gallstone pancreatitis within the first 48 hours (27).…”

Single stage treatment of cholelithiasis and choledocholithiasis: Report of first cases with combined endoscopic and laparoscopic technique

“…Though there are reports in the literature of one-third of patients encountering recurrence within an interval of four to six weeks, which may increase with time, after ERCP, the waiting period for cholecystectomy varies from two to three days to four to six weeks in different institutions. [11][12][13][14][15] There are even some studies for All results are presented as medians (IQR25-IQR75).…”

Department of Pharmacology, Dr.L.H.Hiranandani College of Pharmacy Ulhasnagar, Mumbai.

“…25 It is proposed that delayed cholecystectomy may result in recurrence of gallstone pancreatitis which may increase the mortality, morbidity and length of hospital stay. 24 Delayed cholecystectomy is associated with recurrent biliary attacks in 25-61% 21,22 and delaying cholecystectomy has no advantage regarding intraoperative complications 20 and may even increase overall morbidity, leading to prolonged hospital stay. 22 Recent literature recommends an early LC after an episode of mild to moderate biliary AP.A cholecystectomy during the same admission is favored.…”

“…24 Delayed cholecystectomy is associated with recurrent biliary attacks in 25-61% 21,22 and delaying cholecystectomy has no advantage regarding intraoperative complications 20 and may even increase overall morbidity, leading to prolonged hospital stay. 22 Recent literature recommends an early LC after an episode of mild to moderate biliary AP.A cholecystectomy during the same admission is favored. 17,19,20 CONCLUSION From our study and the review of literature we conclude that, early laparoscopic cholecystectomy in the index admission in mild and moderate gallstone induced pancreatitis is a feasible and a safe modality for the treatment of acute mild and moderate gallstone pancreatitis and early cholecystectomy decreases the incidence of recurrent episodes of pancreatitis and cholecystitis in patients with gallstones.…”

“…17,19,20 Delayed cholecystectomy is associated with recurrent biliary attacks in 25-61% 21,22 and delaying cholecystectomy has no advantage regarding intraoperative complications 20 and may even increase overall morbidity, leading to prolonged hospital stay. 22 In one study, it was concluded that timing of cholecystectomy seems to have no clinical relevant effect on local or systemic complications, but delayed cholecystectomy is associated with an increase of biliary complications in patients with non-necrotizing biliary acute pancreatitis. 23 It is proposed that delayed cholecystectomy may result in recurrence of gallstone pancreatitis which may increase the mortality, morbidity and length of hospital stay.…”