Comparative evaluation of early laparoscopic cholecystectomy for mild gallstone pancreatitis vs acute cholecystitis

Abstract

Laparoscopic cholecystectomy (LC) during index admission for acute cholecystitis (AC) is now an established procedure, but timing for LC in gallstone-induced acute biliary pancreatitis (ABP) is still controversial. Interval cholecystectomy is justified in cases of severe pancreatitis, however, in patients with mild disease, which constitute the majority (80%) of the cases, patients can safely be operated during the index admission. The profile of patients with mild gallstone pancreatitis and AC appears to be similar, since both are complications of gallstone disease. The LC in both situations is equally challenging, due to risk of inflammation and adhesions. However, both conditions are likely to benefit from early LC, in terms of rapid recovery and shortened hospital stay. But no author has compared the outcome of LC in these two similar clinical entities in the past. Hence the present study compares the outcome of LC in case of mild ABP versus AC. This prospective study was conducted on 77 patients undergoing LC for AC with or without pancreatitis, during index admission. Cases were divided into two groups of mild ABP (n=25) and AC (n=52). Both groups were compared with respect to the clinical presentation, timing of cholecystectomy, operative findings, duration of surgery, difficulty in dissection, intra-operative or postoperative complications, duration of hospital stay and outcome at time of discharge. The majority of patients in both groups underwent successful LC. Both groups were comparable, with respect to demographic profile, mean duration of surgery, gallbladder adhesions (32% vs 29%), thickened edematous gallbladder (76% vs 71%), difficult dissection (32% vs 29%) and need of conversion to open procedure (16% vs 17%). Both groups were also comparable, with respect to intra-operative complications (8% vs 10%). Post operative recovery was prolonged in case of ABP, in comparison to AC, but was not significant statistically (p >0.05). Total post-operative complications were significantly more in ABP group (p <0.01). Post operative stay (mean days 2.76 vs 2.34), as well as total hospital stay (mean days 7.24 vs 5.15) was significantly prolonged in cases with ABP (p <0.05). LC can be safely performed during index admission in patients with mild ABP as can be done in cases of AC.