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Surgeon. 2014 Jun;12(3):134-40. doi: 10.1016/j.surge.2013.07.006. Epub 2013 Nov 7.

The impact of timing of cholecystectomy following gallstone pancreatitis.

Author information

  • 1West Midlands Research Collaborative, c/o Martha Holmes, Academic Department of Surgery, Room 29, 4th Floor, Queen Elizabeth Hospital, Edgbaston, Birmingham B15 2TH, United Kingdom. Electronic address: mariannejohnstone@hotmail.com.
  • 2West Midlands Research Collaborative, c/o Martha Holmes, Academic Department of Surgery, Room 29, 4th Floor, Queen Elizabeth Hospital, Edgbaston, Birmingham B15 2TH, United Kingdom.

Abstract

INTRODUCTION:

Current guidelines for the management of acute gallstone pancreatitis recommend cholecystectomy as definitive treatment during primary admission or within 2 weeks of discharge, with the aim of preventing recurrent pancreatitis. However, cholecystectomy during the inflammatory phase may increase surgical complication rates. This study aimed to determine whether adherence to the guidelines prevents recurrent pancreatitis while minimising surgical complications.

METHODS:

Multi-centre review of seven UK hospitals, indentifying patients presenting with their first episode of gallstone pancreatitis between 2006 and 2008.

RESULTS:

A total of 523 patients with gallstone pancreatitis were identified, of which 363 (69%) underwent cholecystectomy (72 during the primary admission or within 2 weeks of discharge; 291 following this). Overall, 7% of patients had a complication related to cholecystectomy of which a greater proportion occurred when cholecystectomy was performed within guideline parameters (13% vs 6%; p = 0.07). 11% of patients were readmitted with recurrent pancreatitis prior to surgery, with those undergoing cholecystectomy outside guideline parameters being most at risk (p = 0.006).

CONCLUSION:

This study suggests cholecystectomy within guideline parameters significantly reduces recurrence of pancreatitis but may increase the risk of surgical complications. A prospective randomised study to assess the associated morbidity is required to inform future guidelines.

Crown Copyright © 2013. Published by Elsevier Ltd. All rights reserved.

KEYWORDS:

BSG guidelines; Cholecystectomy; ERCP; Gallstone pancreatitis

PMID:
24210949
[PubMed - in process]
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