Determining the optimal time interval for cholecystectomy in moderate to severe gallstone pancreatitis: A systematic review of published evidence

Hughes, Daniel Llwyd; Morris‐Stiff, Gareth

doi:10.1016/j.ijsu.2020.11.016

Cited by 13 publications

(15 citation statements)

References 33 publications

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“…10-14 How- The risk of gallstone-related events progressively increases with time if cholecystectomy is not performed. A systematic review of current guidelines by Hughes et al 29 showed that it is common practice not to recommend surgery until peripancreatic collections have completely resolved or at least 6 weeks after onset. However, data from the Dutch Pancreatitis Study Group 5 showed that the risk of biliary events in patients with necrotizing pancreatitis increased when cholecystectomy was postponed, with a turning point at 8 weeks after discharge for recurrent pancreatitis and at 10 weeks for recurrent biliary events overall.…”

Section: Discussionmentioning

confidence: 99%

“…Nevertheless, whether a same-admission or early cholecystectomy (EC) should be indicated in patients with moderately severe and severe ABP is still debatable. There are conflicting data, 5,20,21 based on a few small retrospective studies, [22][23][24][25][26][27][28] as reflected by a previous systematic review of current guidelines, 29 which demonstrated that current recommendations are based on a quality of evidence not above level 2C, according to the Oxford Centre for Evidence-Based Medicine. 30 Therefore, considering the lack of equipoise on the timing of cholecystectomy in patients with moderately severe and severe ABP, it is critical to assess the safety and outcomes of EC in such patients.…”

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confidence: 99%

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Timing of Cholecystectomy After Moderate and Severe Acute Biliary Pancreatitis

Di Martino,

Ielpo,

Pata

et al. 2023

JAMA Surg

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ImportanceConsidering the lack of equipoise regarding the timing of cholecystectomy in patients with moderately severe and severe acute biliary pancreatitis (ABP), it is critical to assess this issue.ObjectiveTo assess the outcomes of early cholecystectomy (EC) in patients with moderately severe and severe ABP.Design, Settings, and ParticipantsThis cohort study retrospectively analyzed real-life data from the MANCTRA-1 (Compliance With Evidence-Based Clinical Guidelines in the Management of Acute Biliary Pancreatitis) data set, assessing 5304 consecutive patients hospitalized between January 1, 2019, and December 31, 2020, for ABP from 42 countries. A total of 3696 patients who were hospitalized for ABP and underwent cholecystectomy were included in the analysis; of these, 1202 underwent EC, defined as a cholecystectomy performed within 14 days of admission. Univariable and multivariable logistic regression models were used to identify prognostic factors of mortality and morbidity. Data analysis was performed from January to February 2023.Main OutcomesMortality and morbidity after EC.ResultsOf the 3696 patients (mean [SD] age, 58.5 [17.8] years; 1907 [51.5%] female) included in the analysis, 1202 (32.5%) underwent EC and 2494 (67.5%) underwent delayed cholecystectomy (DC). Overall, EC presented an increased risk of postoperative mortality (1.4% vs 0.1%, P &lt; .001) and morbidity (7.7% vs 3.7%, P &lt; .001) compared with DC. On the multivariable analysis, moderately severe and severe ABP were associated with increased mortality (odds ratio [OR], 361.46; 95% CI, 2.28-57 212.31; P = .02) and morbidity (OR, 2.64; 95% CI, 1.35-5.19; P = .005). In patients with moderately severe and severe ABP (n = 108), EC was associated with an increased risk of mortality (16 [15.6%] vs 0 [0%], P &lt; .001), morbidity (30 [30.3%] vs 57 [5.5%], P &lt; .001), bile leakage (2 [2.4%] vs 4 [0.4%], P = .02), and infections (12 [14.6%] vs 4 [0.4%], P &lt; .001) compared with patients with mild ABP who underwent EC. In patients with moderately severe and severe ABP (n = 108), EC was associated with higher mortality (16 [15.6%] vs 2 [1.2%], P &lt; .001), morbidity (30 [30.3%] vs 17 [10.3%], P &lt; .001), and infections (12 [14.6%] vs 2 [1.3%], P &lt; .001) compared with patients with moderately severe and severe ABP who underwent DC. On the multivariable analysis, the patient’s age (OR, 1.12; 95% CI, 1.02-1.36; P = .03) and American Society of Anesthesiologists score (OR, 5.91; 95% CI, 1.06-32.78; P = .04) were associated with mortality; severe complications of ABP were associated with increased mortality (OR, 50.04; 95% CI, 2.37-1058.01; P = .01) and morbidity (OR, 33.64; 95% CI, 3.19-354.73; P = .003).Conclusions and RelevanceThis cohort study’s findings suggest that EC should be considered carefully in patients with moderately severe and severe ABP, as it was associated with increased postoperative mortality and morbidity. However, older and more fragile patients manifesting severe complications related to ABP should most likely not be considered for EC.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Timing of Cholecystectomy After Moderate and Severe Acute Biliary Pancreatitis

Di Martino,

Ielpo,

Pata

et al. 2023

JAMA Surg

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“…In four meta-analyses [79][80][81][82] comparing early cholecystectomy with delayed cholecystectomy for mild gallstone-induced pancreatitis based on the revised Atlanta Classification, 83 the conversion rate to laparotomy and postoperative complications were similar in the two groups. For cholecystectomy for severe gallstone-induced pancreatitis, Hughes et al 84 in 2020 reviewed various guidelines and previous reports: although the evidence was low in all guidelines, delayed cholecystectomy was often recommended after pancreatitis had subsided or more than 6 weeks after the onset. However, due to the fact that pseudocysts form approximately 4 weeks after the onset of pancreatitis and that advances in endoscopic drainage have reduced the frequency of surgical treatment for peripancreatic fluid collection, it may not be necessary to wait until 6 weeks for cholecystectomy.…”

Section: Cq24 What Is the Appropriate Timing To Perform Cholecystecto...mentioning

confidence: 99%

JPNclinical practice guidelines 2021 with easy‐to‐understand explanations for the management of acute pancreatitis

Takada

Isaji

Mayumi

et al. 2022

J Hepato Biliary Pancreat

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Background In preparing the Japanese (JPN) guidelines for the management of acute pancreatitis 2021, the committee focused the issues raised by the results of nationwide epidemiological survey in 2016 in Japan. Method In addition to a systematic search using the previous JPN guidelines, papers published from January 2014 to September 2019 were searched for the contents to be covered by the guidelines based on the concept of GRADE system. Results Thirty‐six clinical questions (CQ) were prepared in 15 subject areas. Based on the facts that patients diagnosed with severe disease by both Japanese prognostic factor score and contrast‐enhanced computed tomography (CT) grade had a high fatality rate and that little prognosis improvement after 2 weeks of disease onset was not obtained, we emphasized the importance of Pancreatitis Bundles, which were shown to be effective in improving prognosis, and the CQ sections for local pancreatic complications had been expanded to ensure adoption of a step‐up approach. Furthermore, on the facts that enteral nutrition for severe acute pancreatitis was not started early within 48 h of admission and that unnecessary prophylactic antibiotics was used in almost all cases, we emphasized early enteral nutrition in small amounts even if gastric feeding is used and no prophylactic antibiotics are administered in mild pancreatitis. Conclusion All the members of the committee have put a lot of effort into preparing the extensively revised guidelines in the hope that more people will have a common understanding and that better medical care will be spread.

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“…However, the definition of early varies among guidelines, the British society of Gastroenterology recommend cholecystectomy within the same hospital admission or up to 2 weeks after discharge. The American Gastroenterological Association guidelines suggest that cholecystectomy should be performed as soon as possible and in no case beyond 2-4 weeks after discharge, whereas the American college of Gastroenterology recommends cholecystectomy within the same hospital admission [9]. In young, otherwise healthy patients early laparoscopic cholecystectomy is considered the treatment of choice for acute Calculous cholecystitis.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Laparoscopic Cholecystectomy in the Treatment of Early Acute Cholecystitis

2023

Al-Azhar University Journal of Virus Researches and Studies

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Acute cholecystitis is inflammation of gall bladder wall. Laparoscopic cholecystectomy has become the gold standard in the treatment of symptomatic gall stones. The aim of this work is to evaluate laparoscopic cholecystectomy in the treatment of early acute cholecystitis. Twenty patients were included in this study; this study is analytical prospective study; it was carried out on 20 patients presented with acute cholecystitis admitted in the general surgery department at AL-Zahraa University Hospital in the period from March 2021 to September 2021.All patients diagnosed as acute cholecystitis clinically followed by ultrasonography and laboratory data. Our study revealed that the mean age was (39.65 ± 11.31) and the range was( 18-57), female patients were 11 (55%) and male patients were 9 (45%), Murphy sign was +ve in 16(80%), fever was in 15(75%),leukocytosis in 9 (45%) there was intraoperative dense fibrous adhesions in 2(10%) , fibrinous adhesions in 9 (45%) and omentum only in 7 (35%) , intraoperative phlegmon in the form of omentum and bowel in 2 (10%) and the form of pyocele in 2 (10%) . intra operative decompression in 3(15%), intra operative spillage of GB content in 4(20%), there was conversion to open in 2(10%) and this was due to severe adhesions, postoperative fever in 2(10%). postoperative pain was mild in 18(90%) and moderate in 2(10%). Early laparoscopic cholecystectomy is safe, effective and feasible. It had no increase in operative time, perioperative complication.

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Determining the optimal time interval for cholecystectomy in moderate to severe gallstone pancreatitis: A systematic review of published evidence

Cited by 13 publications

References 33 publications

Timing of Cholecystectomy After Moderate and Severe Acute Biliary Pancreatitis

Timing of Cholecystectomy After Moderate and Severe Acute Biliary Pancreatitis

JPNclinical practice guidelines 2021 with easy‐to‐understand explanations for the management of acute pancreatitis

Evaluation of Laparoscopic Cholecystectomy in the Treatment of Early Acute Cholecystitis

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