BACKGROUND: The timing of cholecystectomy in gallstone pancreatitis remains controversial. We hypothesized that in patients with mild to moderate gallstone pancreatitis (three or fewer Ranson's criteria), performing early cholecystectomy before resolution of laboratory or physical examination abnormalities would result in shorter hospitalization, without adversely affecting outcomes. STUDY DESIGN: An observational study consisting of a retrospective and a prospective group was conducted. For the prospective group, a deliberate policy of early cholecystectomy (less than 48 hours from admission) was used. The primary end point was total length of hospital stay. Secondary endpoints were time from admission to definitive operation, need for endoscopic retrograde cholangiography, and major complications (organ failure and death). RESULTS: Group I consisted of 177 patients retrospectively reviewed, and Group II was composed of 43 patients prospectively followed. There were no differences between the two groups with respect to demographics. With respect to admission laboratory values, there was a significant difference in median serum amylase, but there were no differences in median serum levels of lipase, total bilirubin, albumin, white blood cell count, or Ranson's score. The median length of hospital stay was 7 days in Group I versus 4 days in Group II (p=or< 0.001). Median time from admission to cholecystectomy was 5 days in Group I versus 2 days in Group II (p=or< 0.0001). Complication rates were similar and there were no deaths in either group. CONCLUSIONS: In patients with mild to moderate gallstone pancreatitis, a policy of early cholecystectomy resulted in a significantly reduced length of hospital stay with no increase in complications or mortality.
BACKGROUND: The timing of cholecystectomy in gallstone pancreatitis remains controversial. We hypothesized that in patients with mild to moderate gallstone pancreatitis (three or fewer Ranson's criteria), performing early cholecystectomy before resolution of laboratory or physical examination abnormalities would result in shorter hospitalization, without adversely affecting outcomes. STUDY DESIGN: An observational study consisting of a retrospective and a prospective group was conducted. For the prospective group, a deliberate policy of early cholecystectomy (less than 48 hours from admission) was used. The primary end point was total length of hospital stay. Secondary endpoints were time from admission to definitive operation, need for endoscopic retrograde cholangiography, and major complications (organ failure and death). RESULTS: Group I consisted of 177 patients retrospectively reviewed, and Group II was composed of 43 patients prospectively followed. There were no differences between the two groups with respect to demographics. With respect to admission laboratory values, there was a significant difference in median serum amylase, but there were no differences in median serum levels of lipase, total bilirubin, albumin, white blood cell count, or Ranson's score. The median length of hospital stay was 7 days in Group I versus 4 days in Group II (p=or< 0.001). Median time from admission to cholecystectomy was 5 days in Group I versus 2 days in Group II (p=or< 0.0001). Complication rates were similar and there were no deaths in either group. CONCLUSIONS: In patients with mild to moderate gallstone pancreatitis, a policy of early cholecystectomy resulted in a significantly reduced length of hospital stay with no increase in complications or mortality.
Authors: Krislynn M Mueck; Shuyan Wei; Claudia Pedroza; Karla Bernardi; Margaret L Jackson; Mike K Liang; Tien C Ko; Jon E Tyson; Lillian S Kao Journal: Ann Surg Date: 2019-09 Impact factor: 12.969