Optimizing cholecystectomy time in moderate acute biliary pancreatitis: A randomized clinical trial study

Abstract

Background: In mild to moderate gallstone pancreatitis, cholecystectomy is the most appropriate treatment for prevention of further biliary attacks. However, the timing of cholecystectomy is not precisely determined. The present study was conducted to compare outcomes of very early (within 48 h) versus delayed (more than 1 week) laparoscopic cholecystectomy in patients with acute biliary pancreatitis (ABP). . Two hundred and eight cases with mild to moderate ABP were randomly assigned to 2 groups, with 104 patients in group 1 (operation within 48 h) and 104 in group 2 (operation after one week). Age, sex, biochemical parameters, clinical manifestation at the time of admission, operation time, recurrent biliary problems, relapse, peri-operative complications, conversion rate, and hospital length of stay in the two groups were recorded and compared. In addition, Ranson's score and Revised Atlanta criteria, the American Society of Anaesthesiologists Physical Status ASA-PS, Charlson Co-Morbidity Index (CCI), complexity of surgery and Clavien-Dindo score were also determined. Results: There were no differences in demographics, peri-operative complications 4 (4%) vs. 4 (4%), P ¼ 1), conversion rate (10.6% vs. 11.5%; P ¼ 0.825) and procedure time (83 vs. 81 minutes, P ¼ 0.110) between the two groups. There were no deaths in either group; however, the length of hospital stay was shorter in the early group compared to the delayed one, (3.66 AE 1.12 vs. 10.35 AE 1.76, P < 0.001). Conclusion: Cholecystectomy within 48 h decreases significantly the length of hospital stay, without any difference in conversion rate, procedure time, or complication rate.

Attenuation around the gallbladder on plain abdominal computed tomography as a predictor of surgical difficulty in laparoscopic cholecystectomy

“…In the univariate analysis, significant differences were observed in the patients with an albumin level <3.5 g/dL, CRP level ≥5 mg/dL, moderate (grade II) or severe (grade III) acute cholecystitis according to the TG18 classification, and the CT attenuation around the gallbladder ≥1.4. In the .003 AST (IU/L) 20 [16,30] 24 [16,47] 27 [22,36] .093 ALT (IU/L) 20 [16,32] 25 [13,55] 24 [20,39] . multivariate analysis, CRP levels of ≥5 mg/dL and the CT attenuation around the gallbladder of ≥1.4 were identified as independent predictive factors of difficult surgical cases (Table 2).…”

“…4,[11][12][13][14][15][16][17][18] The superiority of early surgery was confirmed in studies of cholecystectomies after both the treatment of choledocholithiasis with endoscopic retrograde cholangiopancreatography and acute pancreatitis. [19][20][21][22][23] Consequently, surgery is recommended within 72 hours from the onset of acute cholecystitis. Abbreviations: γ-GTP, γ-glutamyl transpeptidase; ALP, alkaline phosphatase; ALT, alanine aminotransferase; AST, aspartate aminotransferase; CRP, C-reactive protein; CT, computed tomography; eGFR, estimated glomerular filtration rate; PLT, platelet count; TG, Tokyo guidelines; WBC, white blood count.…”

Early Versus Delayed Cholecystectomy for Acute Biliary Pancreatitis: A Systematic Review and Meta‐Analysis

“…Our search strategy (Appendix 1) yielded 2584 results from which finally,11 randomized trials [12][13][14][15][16][17][18][19][20][21][22] were included, summarized in PRISMA flow diagram (Fig. 1) Study characteristics are summarized in Table 1 Risk of bias assessment All trials, except one, had low risk of bias for completeness of outcome data.…”

A narrative review of acute pancreatitis and its diagnosis, pathogenetic mechanism, and management

“…The optimal timing and method for the treatment of biliary stones in patients with acute biliary pancreatitis remain controversial (140,141). For patients with MAP, laparoscopic cholecystectomy is recommended during the initial period of hospitalization (142) and may shorten the length of hospital stay and decrease the risk of gallstone recurrence, without an increased risk of conversion to open cholecystectomy, complication, or increase in procedural time (143)(144)(145). Therefore, laparoscopic cholecystectomy should not be delayed for 2 or more weeks (144,146).…”

“…For patients with MAP, laparoscopic cholecystectomy is recommended during the initial period of hospitalization (142) and may shorten the length of hospital stay and decrease the risk of gallstone recurrence, without an increased risk of conversion to open cholecystectomy, complication, or increase in procedural time (143)(144)(145). Therefore, laparoscopic cholecystectomy should not be delayed for 2 or more weeks (144,146). ERCP should be performed urgently (i.e., within 24 hours) for SAP associated with acute cholangitis, as a delay is associated with an increased risk of mortality (16,17,(147)(148)(149).…”