Timing of cholecystectomy for biliary pancreatitis: do the data support current guidelines?

Abstract

BACKGROUND:

Current guidelines suggest that cholecystectomy be performed within 2 weeks after discharge following an episode of biliary pancreatitis. We hypothesized that a high incidence of gallstone-related events is present within 2 weeks after discharge prior to cholecystectomy.

METHODS:

Two hundred eighty-one patients who underwent cholecystectomy for biliary pancreatitis (January 1999-December 2005) were categorized into one of two groups: group A patients underwent cholecystectomy during index admission (n = 162), and group B patients underwent cholecystectomy following discharge from index admission (n = 119).

RESULTS:

Groups were comparable in demographics, comorbidities, and disease severity. Thirty-nine (32.8%) group B patients experienced pre-cholecystectomy gallstone-related events (including 16 cases of recurrent pancreatitis) after discharge. Recurrences (31.3%) occurred within 2 weeks after discharge. Endoscopic sphincterotomy protected against preoperative recurrent pancreatitis but was associated with a higher incidence of other gallstone-related events. Median total length of hospital stay was greater for group B than for group A [7 (range, 2-37) days vs. 5 (1-45) days, respectively, p = 0.00].

CONCLUSION:

Current guidelines suggesting the appropriateness of waiting up to 2 weeks for cholecystectomy for biliary pancreatitis may place patients at unacceptably high risk for recurrence. Endoscopic sphincterotomy does not eliminate the risk of gallstone-related events.

• Authors: Kaori Ito, Hiromichi Ito, Edward E Whang
• Journal: Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract (J Gastrointest Surg) Vol. 12 Issue 12 Pg. 2164-70 (Dec 2008) ISSN: 1873-4626 [Electronic] United States
• PMID: 18636298 (Publication Type: Journal Article)

Topics

• Adult
• Aged
• Aged, 80 and over
• Chi-Square Distribution
• Cholangiopancreatography, Endoscopic Retrograde
• Cholecystectomy
• Cholecystectomy, Laparoscopic
• Comorbidity
• Female
• Gallstones (complications, diagnostic imaging, epidemiology, surgery)
• Humans
• Incidence
• Length of Stay (statistics & numerical data)
• Male
• Middle Aged
• Pancreatitis (complications, diagnostic imaging, epidemiology, surgery)
• Practice Guidelines as Topic
• Recurrence
• Severity of Illness Index
• Sphincterotomy, Endoscopic
• Time Factors
• Tomography, X-Ray Computed