Timing of Cholecystectomy for Acute Biliary Pancreatitis: Outcomes of Cholecystectomy on First Admission and after Recurrent Biliary Pancreatitis (original) (raw)
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Acute Biliary Pancreatitis-Optimal Time for Cholecystectomy : A Prospective Randomized Study
2018
Background: Cholecystectomy can prevent recurrent attacks of mild Acute Biliary Pancreatitis (ABP). However, the optimal timing of cholecystectomy remains controversial. The aim of this prospective randomized study is to compare the outcomes of Early Laparoscopic Cholecystectomy (ELC) vs. Delayed Laparoscopic Cholecystectomy (DLC) for patients with mild ABP. Methods: From June 2014 to December 2017, 131 patients with mild ABP were prospectively randomized to either an ELC group (70 patients) or control DLC group (61 patients). The primary outcomes were gallstone-related morbidity and mortality while the secondary outcomes were success and failure rate, the difficulty of cholecystectomy, operative time, cholecystectomy related complications, readmission for gallstone-related complications, hospital stay, ICU admission and additional procedure. The study was registered in the ClinicalTrials.gov PRS register with identification number NCT03085407. Results: There were statistically sign...
2022
Background Although current guidelines recommend cholecystectomy during the same admission in patients with mild acute biliary pancreatitis (ABP), it involves a waiting list most of the time. Aim We aimed to assess the risk of gallstone-related biliary events (GRBEs) such as cholecystitis, cholangitis, and pancreatitis during the waiting period for cholecystectomy and determine predictors of complications after the first episode of ABP. Methods A prospective observational study was conducted at a tertiary hospital for six months in patients with mild ABP. Follow-ups were done by phone calls or using electronic health records for a maximum of 6 months after discharge or until cholecystectomy. Results A total of 194 patients were included in the study. Although all patients were referred to surgeons, only 81 (41.8%) underwent cholecystectomy within 6 months after discharge. During the observation period, GRBEs developed in 68 (35.1%) patients which included biliary colic, recurrent AB...
Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University
Objective: The objective is to determine the adequacy of early cholecystectomy (EC) versus interval cholecystectomy (IC) in terms of recurrence, duration of hospital admission, and perioperative complications after mild acute biliary pancreatitis (MABP). Methodology: After endorsement from the ethical committee, clinical data and files of all the admitted patients having MABP in the general surgery department of Holy Family Hospital, Rawalpindi, was collected retrospectively from August 2017 to July 2020. The patients’ demographic profile, clinical findings, diagnostic investigations, timing of cholecystectomy, operating surgeons, operative time, biliary complications, intraoperative bleeding, conversion rate, duration of admission, and recurrence were reviewed. Patients presented with abdominal pain, vomiting, jaundice, or fever. The diagnosis was confirmed on the basis of a CT scan of the abdomen showing an inflamed pancreas and stones in the gallbladder. Outcomes were compared an...
International Surgery Journal
Background: Objective of the study was to compare the outcomes of early versus late cholecystectomy in mild to moderate acute biliary pancreatitis.Methods: This comparative prospective study was conducted at Surgical Department of Qazi Hussain Ahmed Medical Complex, Nowshera from 1st January 2018 to 31st March 2020. Patients with mild to moderate acute biliary pancreatitis (ABP) were included in the study. Patients were divided into two groups. Group 1 having patients undergoing early (operated in 7 days) and Group 2 having patients with delayed (operated after 6 weeks) laparoscopic cholecystectomy. The outcomes like hospital stay, peri and post-operative complications, recurrent cholecystitis and pancreatitis were compared. P<0.05 was considered significant.Results: A total of 300 patients were included with 150 in each group. There were 70 (46.66%) males in group 1 while group 2 consisted of 68 (45.33%) males. The median time interval of operation to the laparoscopic surgery wa...
International Surgery Journal
Background: In patients with acute biliary pancreatitis, cholecystectomy is mandatory to prevent further biliary events, but the precise timing of cholecystectomy for mild to moderate disease remain a subject of ongoing debate. The aim of this study is to assess the outcomes of early versus delayed cholecystectomy. We hypothesize that early cholecystectomy as compared to delayed cholecystectomy reduces recurrent biliary events without a higher peri-operative complication rate.Methods: Patients with mild to moderate ABP were prospectively randomized to either an early cholecystectomy versus a delayed cholecystectomy group. Recurrent biliary events, peri-operative complications, conversion rate, length of surgery and total hospital length of stay between the two groups were evaluated.Results: A total of 70 patients were enrolled at tertiary care hospital in central India. Of them, 35were randomized to the early group and 35 patients to the delayed group using simple randomization tech...
Heliyon, 2020
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). Methods: This randomized clinical trial study was conducted in Shahid Beheshti Hospital of Kashan University of Medical Sciences from September 2016 to Mar 2019. 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.
Diagnostic evaluation prior to cholecystectomy in mild-moderate acute biliary pancreatitis
Annali italiani di chirurgia
The importance of papillary obstruction in the pathogenesis of acute biliary pancreatitis (ABP) is widely recognized. The aim of this study was to evaluate the usefulness of the MRCP before the VLC in the patients with mild acute biliary pancreatitis. In the period 2003-2008, 47 patients were submitted to a MRCP (F/M: 28/19) with mild ABP without increase of the cholestasis tests and absence of choledocholithiasis at the abdominal US. During a follow up from 30 to 60 days after the VLC, the presence of jaundice or relapse of ABP were evaluated in all patients. Thirteen patients had diagnosis of choledocholithiasis at the MRCP and they were submitted to an ERCP endoscopic sphincterotomy and stones removal; 34 patients with a negative MRCP were submitted to the VLC. Among these, on 10th postoperative days, one patient has had recurrent ABP, and was submitted to ERCP/ES. All the 47 patients submitted to the MRCP before the VLC did not have jaundice or relapse of the ABP during the foll...
Early laparoscopic cholecystectomy following acute biliary pancreatitis expedites recovery
Turkish Journal of Trauma and Emergency Surgery, 2017
BACKGROUND: In this retrospective study, we aimed to assess the reliability of early cholecystectomy, risk of recurrent biliary pancreatitis, and their effects on hospital length of stay and morbidity by comparing the results of early and late laparoscopic cholecystectomy in patients with acute biliary pancreatitis. METHODS: A total of 131 patients, who were diagnosed with acute biliary pancreatitis at Okmeydanı Education and Research Hospital in January 2009-December 2012, were included in the study. Demographic specifications of patients, duration of their complaints, biochemistry and hemogram values at first arrival, Ranson criteria, number of attacks, screenings, operation type and period, number of days between the first attack and operation, hospital length of stay, and complications were recorded. Patients who underwent cholecystectomy within the first 2 weeks were considered early (group 1) and those who under the operation after 2 weeks were considered late (group 2). RESULTS: There were 47 patients in group 1 and 84 patients in group 2. Open surgery was not performed on any patient, and there was no choledoch injury and mortality. The average hospital length of stay was 7.6±3.0 days in group 1 and 10.7±8.3 days in group 2, with a statistically significant difference between the groups (p=0.006). Two or more number of attacks occurred in 15 patients in group 2 (18%), with a statistically significant difference between the groups (p=0.000). CONCLUSION: Laparoscopic cholecystectomy is safe as it does not increase operation time and morbidity in biliary pancreatitis with a Ranson score of ≤3 or cause difficulty in dissection. Late cholecystectomy causes recurrent attacks and increases the hospital length of stay and treatment costs. Using randomized controlled studies, the effectiveness and reliability of early cholecystectomy in mild and moderate biliary pancreatitis can be verified.