Same-admission versus interval cholecystectomy for mild gallstone pancreatitis in pediatric patients

Abstract

BackgroundThe timing of cholecystectomy for patients with gallstone pancreatitis has been a subject of debate in the past. Data in children are scarce and pediatric guidelines for the management of pancreatitis are mainly based on adult recommendations. The aim of this study was to evaluate the impact of the timing of cholecystectomy on the recurrences of gallstone-related complications and surgery-related complication rates in patients with mild gallstone pancreatitis. MethodsWe conducted a retrospective study on patients with mild gallstone pancreatitis who underwent laparoscopic cholecystectomy between March 2013 and October 2022. Patients were divided into two groups: same-admission cholecystectomy (SAC) and interval cholecystectomy (IC). The primary endpoint was a composite of gallstone-related complications (readmissions before or after cholecystectomy due to recurrent gallstone pancreatitis, choledocholithiasis needing endoscopic retrograde cholangiopancreatography [ERCP] and right upper quadrant [RUQ] pain). Secondary endpoints were total recurrent gallstone pancreatitis events (including those that occurred during the same admission); total number of RUQ pain episodes (regardless of the need for re-hospitalization); residual choledocholithiasis needing postoperative ERCP; cholecystectomy-related difficulties/complications (conversion to open surgery, common bile duct injury, or bleeding), operating time, postoperative length of stay (LOS) and total LOS. ResultsEighty-five patients were included in the analysis. Of these, 47 (55.3 %) had SAC and 38 (44.7 %) interval surgery. Readmissions for gallstone-related complications occurred in 18 (47.4 %) patients in the IC group, compared to 2 (4.3 %) in the SAC group (p = 0.0001). Same-admission cholecystectomy provides a relative risk reduction of readmission of 90.9 %. The incidence of total recurrent gallstone pancreatitis events was higher in the IC group (p = 0.008). Patients in the SAC group had a longer operating time (p = 0.019). There were no differences in the rates of choledocholithiasis needing postoperative ERCP, total number of RUQ pain episodes and total LOS. There were no cholecystectomy-related difficulties/complications in either group. ConclusionIn pediatric patients with mild gallstone pancreatitis, SAC is safe and reduces the risk of readmissions and recurrent gallstone-related complications, compared to IC.