Timing of cholecystectomy in acute biliary pancreatitis: is it still reasonable to wait?

BACKGROUND

Acute gallstone-related pancreatitis is a potentially life-threatening condition, and its adequate therapy is represented by cholecystectomy. The aim of this study was to analyze the best surgical strategy, and the optimal timing.

METHODS

All cases of acute pancreatitis of biliary origin occurred between January 2007 and December 2013 in Gradenigo Hospital (Turin, Italy) undergone to a surgical procedure, were reviewed. Patients were divided in two groups, based on the timing of cholecystectomy, and compared.

RESULTS

Out of 2233 cholecystectomies performed in the mentioned time interval, we have identified 79 patients that fulfill the selection criteria. 24 patients were treated with an index-stay procedure, while 55 with a delayed approach. Length of stay was significantly lower in patients that underwent to an early laparoscopic cholecystectomy (9 vs. 13 days, P=0.003), while no differences were found in terms of length of intervention, intraoperative complications, postoperative stay and mortality. Patients treated with delayed surgery had a 28.6% recurrence rate of acute pancreatitis, with an odds ratio of 10.28 (P=0.02).

CONCLUSIONS

Early laparoscopic cholecystectomy should be performed in suitable patients in the index admission, reducing overall risks, avoiding or at least minimizing recurrencies, and rationalizing the scarce economic resources.