Cholecystectomy in mild to moderate acute biliary pancreatitis when to intervene: early versus delayed
DOI:
https://doi.org/10.18203/2349-2902.isj20203226Keywords:
Acute biliary pancreatitis, Hospital stay, Laparoscopic cholecystectomy, Post-operative complicationsAbstract
Background: Objective of the study was to compare the outcomes of early versus late cholecystectomy in mild to moderate acute biliary pancreatitis.
Methods: This comparative prospective study was conducted at Surgical Department of Qazi Hussain Ahmed Medical Complex, Nowshera from 1st January 2018 to 31st March 2020. Patients with mild to moderate acute biliary pancreatitis (ABP) were included in the study. Patients were divided into two groups. Group 1 having patients undergoing early (operated in 7 days) and Group 2 having patients with delayed (operated after 6 weeks) laparoscopic cholecystectomy. The outcomes like hospital stay, peri and post-operative complications, recurrent cholecystitis and pancreatitis were compared. P<0.05 was considered significant.
Results: A total of 300 patients were included with 150 in each group. There were 70 (46.66%) males in group 1 while group 2 consisted of 68 (45.33%) males. The median time interval of operation to the laparoscopic surgery was 5 days in group1 and 42 days in group 2. Peri operative outcomes were not significant between two groups (p=0.6). About 14 (09.63%) patients were converted to open surgery in group1 and 17 (10.53%) in group 2. Postoperative complications were also not significant between two groups (p=1.0). Group 1 had small total length of stay as compared to group 2 (p=0.006). Recurrent biliary events occurred in 63 (42.12%) patients in total with no event in group 1.
Conclusions: Patients with mild to moderate ABP having early laparoscopic cholecystectomy present with reduced recurrent biliary events and the total length of hospital.
Metrics
References
Papi C, Catarci M, D’Ambrosio L, Gilli L, Koch M, Grassi GB, et al. Early surgery for acute calculous cholecystitis is better than delayed. Am J Gastroenterol. 2004;99:147-55.
Ranson JHC. The timing of biliary surgery in acute pancreatitis. Ann Surg. 1979;189:654-63.
Nadesan S, Qureshi A, Daud A, Ahmad H. Characteristics of acute pancreatitis in University Kebangsaan Malaysia. Med J Malaysia. 1999;54(2):235-41.
Forsmark CE, Baillie J. AGA Institute technical review on acute pancreatitis. Gastroenterology. 2007;132(5):2022-44.
Working Party of the British Society of Gastroenterology. UK guidelines for the management of acute pancreatitis. Gut. 2005;54(3:iii):1e9.
Banks PA, Freeman ML. Practice guidelines in acute pancreatitis. Am J Gastroenterol. 2006;101(10):2379-400.
Tenner S, Baillie J, DeWitt J, Vege SS. American College of Gastroenterology guideline: management of acute pancreatitis. Am J Gastroenterol. 2013;108(9):1400-15.
Ito K, Ito H, Whang EE. Timing of cholecystectomy for biliary pancreatitis: do the data support current guidelines? J Gastrointest Surg. 2008;12(12):2164-70
Bakker OJ, van Santvoort HC, Hagenaars JC. Timing of cholecystectomy after mild biliary pancreatitis. Br J Surg. 2011;98(10):1446-54.
Tang SC, Stain G, Tang EF, Berne TV. Management of acute pancreatitis: from surgery to interventional intensive care. Gut. 2005;54:426-36.
Tong S, Altkorn D. Acute gallstone pancreatitis: how and when to intervene. Gut. 2005;54:426-36.
Soper NJ, Brunt LM, Callery MP, Steven AE, Giuseppe A. Role of laparascopic cholecystectomy in the management of acute gallstone pancreatitis. Am J Surg. 1994;167:42-51.
Sanjay P, Yeeting S, Whigham C, Judson H, Polignano FM, Tait IS. Endoscopic sphincterotomy and interval cholecystectomy are reasonable alternatives to index cholecystectomy in severe acute gallstone pancreatitis (GSP). Surg Endosc. 2008;22(8):1832-7.
van Baal MC, Besselink MG, Bakker OJ. Timing of cholecystectomy after mild biliary pancreatitis: a systematic review. Ann Surg. 2012;255(5):860-6.
Ito K, Ito H, Whang EE. Timing of cholecystectomy for biliary pancreatitis: do the data support current guidelines? J Gastrointest Surg. 2008;12(12):2164-70
Mador BD, Panton ON, Hameed SM. Early versus delayed cholecystectomy following endoscopic sphincterotomy for mild biliary pancreatitis. Surg Endosc. 2014;28(12):3337-42.
Judkins SE, Moore EE, Witt JE, Barnett CC, Biffl WL, Burlew CC, et al. Surgeons provide definitive care to patients with gallstone pancreatitis. Am J Surg. 2011;202(6):673-8.
Osborne DH, Imrie CW, Carter DC. Biliary surgery in the same admission for gallstone associated acute pancreatitis. Br J Surg. 1981;68:758-61.
Waldemar U, Andrew W, Clement I, Claudio B, Colin J. Mackey, et al. IAP guidelines for the surgical management of acute pancreatitis. Pancreatology. 2002;2:565-73.
Schacter P, Peleg T, Cohen O. Interval laproscopic cholecystectomy in the management of acute biliary pancreatitis. HPB Surg. 2000;11(5):319-23.
Nealon WH, Bawduniak J, Walser EM. Appropriate timing of cholecystectomy in patients who present with moderate to severe gallstone-associated acute pancreatitis with peripancreatic fluid collections. Ann Surg. 2004;23:741-51.
Rosing DK, de Virgilio C, Yaghoubian A, Putnam BA, El Masry M, Kaji A, et al. Early cholecystectomy for mild to moderate gallstone pancreatitis shortens hospital stay. J Am Coll Surg. 2007;205(6):762-6.
