We hypothesized that laparoscopic cholecystectomy performed within 48 hours of admission for mild gallstone pancreatitis, regardless of resolution of abdominal pain or abnormal laboratory values, would result in a shorter hospital stay.
Although there is consensus among surgeons that patients with gallstone pancreatitis should undergo cholecystectomy to prevent recurrence, the precise timing of laparoscopic cholecystectomy for mild disease remains controversial.
Consecutive patients with mild pancreatitis (Ranson score <or=3) were prospectively randomized to either an early laparoscopic cholecystectomy group (within 48 hours of admission) versus a control laparoscopic cholecystectomy group (performed after resolution of abdominal pain and normalizing trend of laboratory enzymes). The primary end point was hospital length of stay. Secondary end point was a composite of rates of conversion to an open procedure, perioperative complications, and need for endoscopic retrograde cholangiography. The study was designed to enroll 100 patients with an interim analysis after 50 patients.
At interim analysis, 50 patients were enrolled at a single university-affiliated public hospital. Of them, 25 patients were randomized to the early group and 25 patients to the control group. Patient age ranged from 18 to 74 years with a median duration of symptoms of 2 days upon presentation and a median Ranson score of 1. There were no baseline differences between the groups with regards to demographics, clinical presentation, or the presence of comorbidities. The hospital length of stay was shorter for the early cholecystectomy group (mean: 3.5 [95% CI, 2.7-4.3], median: 3 [IQR, 2-4]) compared with the control group (mean: 5.8 [95% CI, 3.8-7.9], median: 4 [IQR, 4-6] [P = 0.0016]). Six patients from the early group required endoscopic retrograde cholangiography, compared with 4 in the control group (P = 0.72). There was no statistically significant difference in the need for conversion to an open procedure or in perioperative complication rates between the 2 groups.
In mild gallstone pancreatitis, laparoscopic cholecystectomy performed within 48 hours of admission, regardless of the resolution of abdominal pain or laboratory abnormalities, results in a shorter hospital length of stay with no apparent impact on the technical difficulty of the procedure or perioperative complication rate.
"Historically, early cholecystectomy has been avoided due to the belief that the procedure would be complicated by difficult dissection caused by oedema. However , recent literature suggests early cholecystectomy can be performed with minimal change in morbidity and mortality . Unfortunately there is no consensus on the definition of " early " cholecystectomy. "
[Show abstract][Hide abstract] ABSTRACT: Introduction. Concomitant cholecystitis and gallstone pancreatitis is an infrequent clinical encounter, reported sparsely in the literature. Concurrent acute cholecystitis and pancreatitis complicated by gall bladder perforation has not been reported before. Presentation of Case. We report a 39-year-old female presenting with concomitant cholecystitis and acute pancreatitis, complicated by gallbladder perforation. Discussion. There is much controversy surrounding the timing of cholecystectomy following gallstone pancreatitis, with the recent literature suggesting that "early" operation is safe. In the current case, gallbladder perforation altered the "routine" management of gallstone pancreatitis and posed as a management dilemma. Conclusion. Clinical judgement dictated timing of operative management and ultimately cholecystectomy was performed safely.
[Show abstract][Hide abstract] ABSTRACT: To summarize published research on pancreatic surgery over the past year.
Improvements in the treatment of patients with acute gallstone pancreatitis with regards to the timing of ERCP and cholecystectomy as well as management of pancreatic pseudocysts have been reported. It is often difficult to detect malignancy in neoplastic pancreatic cysts; however, a detailed cyst fluid analysis for protein and genetic markers may improve this accuracy. In order to continue to improve pancreatic cancer care in the United States, a standardized reporting system must be developed, and this was a focus of the American Hepato-Pancreatico-Biliary Association Consensus Conference on Resectable and Borderline Resectable Disease. The conference examined pretreatment assessment, surgical treatment, and combined modality treatment for pancreatic cancer. A multi-institutional randomized clinical trial revealed that routine preoperative decompression of malignant biliary obstruction is associated with a higher frequency of complications. Pancreatic fistulas are the most common source of perioperative morbidity following pancreatic surgery. Fortunately, most of these can be managed nonoperatively via interventional radiology techniques.
There is a broad spectrum of pancreatic diseases, which often require surgical treatment. Fortunately, the morbidity and mortality from each of them continues to decrease with more accurate diagnosis, improved management techniques, and standardized reporting systems.
Current opinion in gastroenterology 09/2010; 26(5):499-505. DOI:10.1097/MOG.0b013e32833d1174 · 4.29 Impact Factor
Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.