Optimal Timing to Perform Cholecystectomy in Patients with Acute Biliary Pancreatitis Timing of Cholecystectomy in Acute Biliary Pancreatitis
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Abstract
Background: Acute biliary pancreatitis accounts for nearly 50% of acute pancreatitis cases, primarily caused by gallstones and biliary sludge. Cholecystectomy remains the definitive treatment to prevent recurrent biliary events, but the optimal timing of surgery remains debated.
Objective: This study aimed to evaluate the optimal timing of cholecystectomy in patients with mild to moderate acute biliary pancreatitis, comparing early cholecystectomy during index admission to delayed cholecystectomy.
Methods: A prospective cohort study was conducted over 24 months at Combined Military Hospital, Kohat, Pakistan. A total of 126 patients aged 18 years and older, diagnosed with mild to moderate acute biliary pancreatitis, were included. Patients with severe pancreatitis, ICU admissions, or requiring ERCP were excluded. Patients were divided into two groups: index admission cholecystectomy and delayed cholecystectomy. Data were analyzed using SPSS 25 with chi-square tests applied. A p-value of <0.05 was considered statistically significant.
Results: Recurrent pancreatitis occurred in 0 patients in the early group versus 41 patients in the delayed group (p < 0.001). The mean hospital stay was significantly shorter in the early group (5.92 vs 12.31 days, p < 0.001).
Conclusion: Early cholecystectomy significantly reduced recurrent biliary events and shortened hospital stay in patients with mild to moderate acute biliary pancreatitis without increasing complications.
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References
Di Martino M, Ielpo B, Pata F, Pellino G, Di Saverio S, Catena F, et al. Timing of Cholecystectomy After Moderate and Severe Acute Biliary Pancreatitis. JAMA Surg. 2023 Oct;158(10)
Lyu Y, Cheng Y, Wang B, Zhao S, Chen L. Safety of Early Same-Admission Laparoscopic Cholecystectomy for Acute Mild Biliary Pancreatitis: A Retrospective Study for Acute Pancreatitis. Videosurgery Miniinvasive Tech. 2022 Mar;17(1):150–5.
Jee SL, Jarmin R, Lim KF, Raman K. Outcomes of Early Versus Delayed Cholecystectomy in Patients With Mild to Moderate Acute Biliary Pancreatitis: A Randomized Prospective Study. Asian J Surg. 2018 Jan;41(1):47–54.
Piele SM, Preda SD, Pătrașcu Ș, Laskou S, Sapalidis K, Dumitrescu D, et al. Indication and Timing of Cholecystectomy in Acute Biliary Pancreatitis: A Systematic Review. Curr Health Sci J. 2024;50(1):125–32.
Davoodabadi A, Beigmohammadi E, Gilasi H, Arj A, Taheri Nassaj H. Optimizing Cholecystectomy Time in Moderate Acute Biliary Pancreatitis: A Randomized Clinical Trial Study. Heliyon. 2020 Feb;6(2)
Facundo HG, Montoliu RR, Llanos DRC, Naval GS, Millán EL, Gordo SL, et al. Cholecystectomy 7 Days Versus 4 Weeks After Mild Biliary Pancreatitis: Looking to Decrease the Incidence of Persistent Choledocholithiasis and ERCP. Int J Surg. 2022 Feb;98:106207.
Leppäniemi A, Tolonen M, Tarasconi A, Segovia-Lohse H, Gamberini E, Kirkpatrick AW, et al. 2019 WSES Guidelines for the Management of Severe Acute Pancreatitis. World J Emerg Surg. 2019 Jun;14:27.
Ackermann TG, Cashin PA, Alwan M, Wewelwala CC, Tan D, Vu AN, et al. The Role of Laparoscopic Cholecystectomy After Severe and/or Necrotic Pancreatitis in the Setting of Modern Minimally Invasive Management of Pancreatic Necrosis. Pancreas. 2020 Aug;49(7):935–40.
Liu JK, Braschi C, de Virgilio CM, Ozao-Choy J, Kim DY, Moazzez A. Early Cholecystectomy in Gallstone Pancreatitis Patients With and Without End Organ Dysfunction: A NQSIP Analysis. Am Surg. 2022 Oct;88(10):2579–83.
da Costa DW, Bouwense SA, Schepers NJ, Besselink MG, van Santvoort HC, van Brunschot S, et al. Same-Admission Versus Interval Cholecystectomy for Mild Gallstone Pancreatitis (PONCHO): A Multicenter Randomized Controlled Trial. Lancet. 2015 Sep;386(10000):1261–8.
Al Taweel B, Tzedakis S, Panaro F. Early Cholecystectomy Cannot Be Regarded as a Mortality Risk Factor in Moderate and Severe Acute Biliary Pancreatitis. Hepatobiliary Surg Nutr. 2024 Feb;13(1):109–11.
Early Versus Delayed Cholecystectomy for Acute Biliary Pancreatitis: A Systematic Review and Meta-Analysis. World J Surg. [Internet] 2024; Available from: https://link.springer.com/article/10.1007/s00268-022-06501-4.