Managing Mild Gallstone Pancreatitis With Laparoscopy

Surgeons have historically delayed cholecystectomy in all patients with gallstone pancreatitis until normalization of pancreatic and liver enzymes and resolution of abdominal pain. However, the era of laparoscopic cholecystectomy (LC) has changed treatment approaches. Because of this, elective LC to remove the source of calculi is routinely performed during the same hospital admission to prevent further episodes. In many cases, patients will undergo LC within 48 hours of hospital admission without waiting for pancreatic and liver enzyme levels to return to normal. Performing LC early has the potential to decrease length of hospital stay and minimize the unnecessary use of endoscopic retrograde cholangiopancreatography (ERCP). However, mild pancreatitis can be unpredictable. Some patients may undergo early operative intervention when the disease is actually evolving into a moderate-to-severe pancreatitis that may result in an exacerbation of their disease. Comparative Data for Laparoscopic Cholecystectomy A retrospective review that my colleagues and I had published in the Archives of Surgery addressed potential concerns about performing LC for mild gallstone pancreatitis. Results showed that the medial hospital length of stay was significantly less for patients receiving early LC (3 days) than for those receiving delayed LC (6 days). Early LC was also associated with decreased use of ERCP. The observed decrease in length of hospital stay in our study was achieved without increases in adverse outcomes. No patients in either cohort died, and complication rates were similar for both study groups. Also, no patient with mild pancreatitis progressed to severe pancreatitis. For patients with mild gallstone pancreatitis, delaying an LC until laboratory values normalize appears to be unnecessary. Operating early in these patients is...