Tolga CANBAK, Aylin ACAR, Hüseyin Kerem TOLAN

Timing of cholecystectomy in the treatment of mild acute biliary pancreatitis

Aim: In this study, we aimed to compare the results of emergency and elective cholecystectomy in patients admitted due to acutebiliary pancreatitis.Material and Methods: A total of 632 patients admitted due to acute biliary pancreatitis were retrospectively evalauted. Patients withRanson ≥ 3 and hour 48 CRP > 15 were considered as severe pancreatitis and excluded from the study. Patients were divided intotwo groups. Group 1 consisted of the patients who underwent emergency cholecystectomy after 48 hours, while Group 2 includedthe patients who underwent interval cholecystectomy.Results: A total of 386 patients were enrolled in the study. Group 1 consisted of 214 patients. The mean Ranson score was found as1.3±0.9 in Group 1 and 0.92±0.7 in Group 2. A total of 148 patients in Group 1 and 117 patients in Group 2 had comorbidity (p=0.81).Conversion was performed in 8 patients in Group 1 and 5 patients in Group 2 (p = 0.78). Bile duct injury was not detected in eithergroup. Among the patients in the interval cholecystectomy group, 7 patients were admitted to the hospital due to acute pancreatititsand total 13 patients due to biliopancreatic reasons during the interval period.Conclusion: No effect of cholecystectomy timing was detected on the conversion rates and development of complications. However,development of recurrence and related complications in the waiting period of the patients could be prevented by performing earlycholecystectomy.

PDF

___

1. Peter A Banks, Thomas L Bollen, Christos Dervenis, et al. Acute Pancreatitis Classification Working Group. Classification of acute pancreatitis. 2012: revision of the Atlanta classification and definitions by international consensus. Gut 2013;62:102-11.
2. Bouwense SA, Besselink MG, van Brunschot S, et al. Pancreatitis of biliary origin, optimal timing of cholecystectomy (PONCHO trial): study protocol for a randomized controlled trial. Trials 2012;13:225.
3. Tenner S, Baillie J, Dewitt J, et al. American College of Gastroenterology guideline: management of acute pancreatitis. Am J Gastroenterol 2013;108:1400-15.
4. Munigala S, Subramaniam D, Subramaniam DP, et al. Predictors for early readmission in acute pancreatitis (AP) in the United States (US) - A nationwide population based study. Pancreatology 2017;17:534-42.
5. Hamada S, Masamune A, Shimosegawa T. Transition of early-phase treatment for acute pancreatitis: An analysis of nationwide epidemiological survey. World J Gastroenterol 2017;23:2826-31.
6. Russo MW, Wei JT, Thiny MT, et al. Digestive and liver disease statistics, 2004. Gastroenterology 2004;126:1448-53.
7. Fagenholz PJ, Castillo CF, Harris NS, et al. Increasing United States hospital admissions for acute pancreatitis, 1988-2003. Ann Epidemiol 2007;17:491- 7.
8. Working Group IAPAPAAPG. IAP/APA evidence-based guidelines for the management of acute pancreatitis. Pancreatology 2013;13:1–15.
9. Forsmark CE, Baillie J. AGA Institute technical review on acute pancreatitis. Gastroenterology 2007;132:2022–44.
10. Ragnarsson T, Andersson R, Ansari D, et al. Acute biliary pancreatitis: focus on recurrence rate and costs when current guidelines are not complied. Scand J Gastroenterol 2017;52:264-9.
11. Bakker OJ, Van Santvoort HC, Hagenaars JC, et al. Timing of cholecystectomy after mild biliary pancreatitis. Br J Surg 2011;98:1446-54.
12. El-Dhuwaib Y, Deakin M, David GG, et al. Definitive management of gallstone pancreatitis in England. Ann R Coll Surg Engl 2012;94:402-6.
13. Chiang DT, Thompson G. Management of acute gallstone pancreatitis: so the story continues. ANZ J Surg 2008;78:52-4.
14. Janisch NH, Gardner TB. Advances in Management of Acute Pancreatitis. Gastroenterol Clin North Am 2016;45:1-8.
15. Gurusamy KS, Nagendran M, Davidson BR. Early versus delayed laparoscopic cholecystectomy for acute gallstone pancreatitis. Cochrane Database Syst Rev 2013;2:CD010326.
16. Van Baal MC, Besselink MG, Bakker OJ, et al: Dutch Pancreatitis Study Group. Timing of cholecystectomy after mild biliary pancreatitis: a systematic review. Ann Surg 2012;255:860-6.
17. Werner J, Feuerbach S, Uhl W, et al. Management of acute pancreatitis: from surgery to interventional intensive care. Gut 2005;54:426-36.
18. Alimoglu O, Ozkan OV, Sahin M, et al. Timing ofcholecystectomy for acute biliary pancreatitis: outcomes of cholecystectomy on first admission and after recurrent biliary pancreatitis. World J Sur 2003;27:256-9.
19. Lein, HH, Huang, CS. Male gender: risk factor for severe symptomatic cholelithiasis. World J Surg 2002;26:598-601.