Optimal timing of laparoscopic cholecystectomy in mild acute gallstone pancreatitis

Abstract

Objective To assess the optimal timing of laparoscopic cholecystectomy (LC) in mild acute gallstone pancreatitis (mAGP). Methods From May 1, 2012 to August 30, 2015, consecutive patients with mAGP were prospectively assessed. Each patient underwent abdominal computed tomography scan within 48 h after mAGP onset to assess the presence of peripancreatitc fluid collection, and Marshall score was used to assess if there was organ failure. Patients with neither peripancreatic fluid collection by CT (classified as grade A, B or C based on the Balthazar CT grading system) nor organ failure by clinical data (Marshall score <2) were randomized according to simple randomization into early laparoscopic cholecystectomy (ELC; LC performed within 7 days after a pancreatitis attack, without waiting for symptom resolution) or late laparoscopic cholecystectomy (LLC; LC performed ≥7 days following an attack, with complete remission of AGP symptoms) group. The mean LC operation time, bleeding during LC, post-LC complications and lengths of hospital stay between the ELC group and LLC group were compered. Results The study enrolled 102 patients with mAGP. A total of 49 and 53 patients were assigned to ELC and LLC group, respectively. The mean LC operation time and lengths of hospital stay were significantly shorter in the ELC group than in the LLC group [(19.9±5.3) vs(31.1±8.4)min; (7.9±1.8) vs (16.8±5.3)d, P<0.05], while there were no significant difference on bleeding during LC and post-LC complications. Conclusions LC for patients with mAGP who had neither peripancreatic fluid collection nor organ failure within 7 days after the onset was safe and feasible. Key words: Pancreatitis; Tomography, X-ray computed; Cholecystectomy, laparoscopic