Data indicate that gallstones are the most common cause of acute pancreatitis in the United States. While patients with gallstone pancreatitis (GSP) ultimately require cholecystectomy to prevent future pancreatitis, the optimal timing of this procedure remains unclear. Many institutions delay cholecystectomy for mild GSP until normalization of laboratory values and abdominal pain resolution based on the belief that early surgery may increase complications. However, previous single and dual institutional studies have shown that early cholecystectomy for mild pancreatitis appears to be associated with shorter length of stay, which can result in lower costs and better patient satisfaction, explains Ashkan Moazzez, MD, MPH. However, the relationship of early cholecystectomy with morbidity in this patient population has not been previously evaluated.
For a study published in JAMA Surgery, Dr. Moazzez, Christian de Virgilio, MD, and colleagues compared data on patients with mild pancreatitis who had received cholecystectomy in less than 48 hours (early) from hospital admission with that of those who underwent the procedure in 48 hours or longer from hospital admission (delayed). Data was extracted from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database for the years 2011-2014.
“Our main findings were that early cholecystectomy in patients with mild gallstone pancreatitis was associated with shorter hospital stay and operative times, but not with higher morbidity or reoperation rates, when compared with delayed cholecystectomy,” says Dr. Moazzez. “While patients in the early cholecystectomy group were more likely to undergo the procedure laparoscopically, early cholecystectomy was associated with more biliary procedures, such as intraoperative cholangiogram and endoscopic retrograde cholangio-pancreatography.”
Dr. Moazzez notes that a large, multi-institutional, randomized study is needed to hopefully confirm the study findings. In meantime, however, he says the findings “further reinforces the notion that early cholecystectomy can be safely performed for patients with mild gallstone pancreatitis and that there is no need to await complete resolution of symptoms or abnormal laboratory values.”
Early vs Delayed Cholecystectomy for Mild Gallstone Pancreatitis