Early Cholecystectomy Safely Decreases Hospital Stay in Patients With Mild Gallstone Pancreatitis A Randomized Prospective Study
ABSTRACT 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.
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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.01/2013; 2013:263046. DOI:10.1155/2013/263046
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ABSTRACT: Background/Aims: The timing for the management of gallstones pancreatitis remains a contentious issue. Various scholars have their own achievement in in regards to this issue. Methodology: We reviewed our hospital charts from Jan 2007 to December 2010 and made a comparative study about early and delayed LC for mild to moderate gallstone pancreatitis in 80 patients. Results: Successful management was obtained in all patients. Out of 80 patients, 54 had underwent for early LC within 48 hours and 26 delayed LC (6-8 weeks). Conclusions: Our study reveals that early cholecystectomy has nice outcomes in terms of shorter hospital stay and expenses. Proper consultation should be taken from radiological colleague if CBD dilations are >6mm and contraction of gallbladder appears on imaging modalities. Comorbid conditions, past history of cholecystitis cannot be avoided for proper surgical outcomes. Postoperative complications can be deterred by early LC for mild gallstone pancreatitis. However, large volume studies are essential from different places to answer the debated topic of which management protocol is justifiable for the management of mild to moderate gall stone pancreatitis.Hepato-gastroenterology 05/2012; 59(119). DOI:10.5754/hge12319 · 0.91 Impact Factor
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ABSTRACT: Gallstone pancreatitis constitutes 40% of all cases with pancreatitis while it constitutes up to 90% of cases with acute pancreatitis. The treatment modality in this patient population is still controversial. In this study, we aimed to compare the results of early and late cholecystectomy for patients with biliary pancreatitis. Patients treated with a diagnosis of acute biliary pancreatitis in our clinics between January 2000 and December 2011 were retrospectively reviewed. Patients were divided into two groups: Group A, patients who underwent cholecystectomy during the first pancreatitis attack, Group B, patients who underwent an interval cholecystectomy at least 8 weeks after the first pancreatitis episode. The demographic characteristics, clinical symptoms, number of episodes, length of hospital stay, morbidity and mortality data were recorded. All data were evaluated with Statistical Package for the Social Sciences (SPSS) 13.0 for windows and p <0.05 was considered as statistically significant. During the last 12 years, a total of 91 patients with surgical treatment for acute biliary pancreatitis were included into the study. There were 62 female and 29 male patients, with a mean age of 57.9±14.6 years (range: 21-89). A concomitant acute cholecystitis was present in 46.2% of the patients. Group A and B included 48 and 43 patients, respectively. The length of hospital stay was significantly higher in group B (9.4 vs. 6.8 days) (p<0,05). More than half of the patients in Group B were readmitted to the hospital for various reasons. No significant difference was observed between the two groups, one patient died due to heart failure in the postoperative period in group B. In-hospital cholecystectomy after remission of acute pancreatitis is feasible. It will not only result in lower recurrence and complication rates but also shorten length of hospital stay. We recommend performing cholecystectomy during the course of the first episode in patients with acute pancreatitis.Turkish Journal of Surgery 03/2014; 30(1):10-13. DOI:10.5152/UCD.2014.2401