DOI: https://dx.doi.org/10.18203/2349-2902.isj20222059
Published: 2022-08-09

Early versus late laparoscopic cholecystectomy in acute biliary pancreatitis: a prospective randomised study

Unmed Chandak, Vishal Pind, Arti Mitra, Prasad Y. Bansod, Umesh Gaikwad, Prachi Ramteke

Abstract


Background: In patients with acute biliary pancreatitis, cholecystectomy is mandatory to prevent further biliary events, but the precise timing of cholecystectomy for mild to moderate disease remain a subject of ongoing debate. The aim of this study is to assess the outcomes of early versus delayed cholecystectomy. We hypothesize that early cholecystectomy as compared to delayed cholecystectomy reduces recurrent biliary events without a higher peri-operative complication rate.

Methods: Patients with mild to moderate ABP were prospectively randomized to either an early cholecystectomy versus a delayed cholecystectomy group. Recurrent biliary events, peri-operative complications, conversion rate, length of surgery and total hospital length of stay between the two groups were evaluated.

Results: A total of 70 patients were enrolled at tertiary care hospital in central India. Of them, 35were randomized to the early group and 35 patients to the delayed group using simple randomization technique. 

Conclusions: In mild to moderate ABP, early laparoscopic cholecystectomy reduces the risk of recurrent biliary events without an increase in operative difficulty or perioperative morbidity.


Keywords


Laparoscopic cholecystectomy, Hot cholecystectomy, Acute biliary pancreatitis, Delayed cholecystectomy, Biliary events

Full Text:

PDF

References


Barbi E, Sgroi S, Tinazzi P, Canestrini S, Gallotti A, D’Onofrio M. Pancreatic anatomy, variants and pseudolesions of the pancreas. Ultrasonography of the Pancreas. Milano; Springer: 2012: 63-81.

Ilhan M, Alıs H. Acute biliary pancreatitis. In: Acute Pancreatitis. India: Intech Open; 2012.

Brunicardi F, Andersen D, Billiar T, Dunn D, Hunter J, Matthews J, Pollock R. Schwartz's principles of surgery. United States: McGraw-hill; 2014.

Floyd A, Pederson L, Nielsen GL, Thorlacius-Ussing O, Sorensen HT. Secular trends in incidence and 30-day case fatality of acute pancreatitis in North Jutland County, Denmark: a register-based study from 1981-2000. Scand J Gastroenterol. 2002;37(12):1461-5.

Sakorafas GH, Tsiotou AG. Etiology and pathogenesis of acute pancreatitis. J Clin Gastroenterol. 2000;30(4):343-56.

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; 41(1):47-54.

Uhl W, Warshaw A, Imrie C. IAP guidelines for the surgical management of acute pancreatitis. Pancreatology. 2002;2(6):565-73.

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;239(6):741-9.

Banks PA, Freeman ML. Practice guidelines in acute pancreatitis. Am J Gastroenterol. 2006;101(10):2379-400.

UK guidelines for the management of acute pancreatitis. Available at: https://gut.bmj.com/. Accessed on 20 October 2021.

Hunter JG. Acute cholecystitis revisited: get it while it's hot. Ann Surg. 1998;227(4):468.

Taylor E, Wong C. The optimal timing of laparoscopic cholecystectomy in mild gallstone pancreatitis. Am Surg. 2004;70(11):971.

Bazoua G, Tilston MP. Male gender impact on the outcome of laparoscopic cholecystectomy. J Soc Laparoendoscop Surg. 2014;18(1):50.

Vege SS, DiMagno MJ, Forsmark CE, Martel M, Barkun AN. Initial medical treatment of acute pancreatitis: American gastroenterological association institute technical review. Gastroenterology. 2018; 154(4):1103-39.

Saritaş Ü, Üstündağ Y. Endoscopic retrograde cholangiopancreatography in acute biliary pancreatitis. In: recent advances in pancreatitis. India: Intech Open; 2021.

Nebiker CA, Frey DM, Hamel CT, Oertli D, Kettelhack C. Early versus delayed cholecystectomy in patients with biliary acute pancreatitis. Surgery. 2009; 145(3):260-4.

Wilson CT, De Moya MA. Cholecystectomy for acute gallstone pancreatitis: early vs delayed approach. Scand J Surg. 2010;99(2):81-5.

Alponat A, Kum CK, Koh BC, Rajnakova A, Goh PM. Predictive factors for conversion of laparoscopic cholecystectomy. World J Surg. 1997;21(6):629-33.

Peters JH, Krailadsiri W, Incarbone R, Bremner CG, Froes E, Ireland AP, et al. Reasons for conversion from laparoscopic to open cholecystectomy in an urban teaching hospital. Am J Surg. 1994;168(6):555-9.

Kama NA, Kologlu M, Doganay M, Reis E, Atli M, Dolapci M. A risk score for conversion from laparoscopic to open cholecystectomy. Am J Surg. 2001;181(6):520-5.

Morgan DE. Imaging of acute pancreatitis and its complications. Clin Gastroenterol Hepatol. 2008; 6(10):1077-85.

Rosing DK, de Virgilio C, Yaghoubian A, Putnam BA, El Masry M, Kaji A, Stabile BE. Early cholecystectomy for mild to moderate gallstone pancreatitis shortens hospital stay. J Am College Surg. 2007;205(6):762-6.