Enhanced recovery in the management of mild gallstone pancreatitis: a prospective cohort study
The aim of this study was to establish enhanced recovery protocols for the management of mild gallstone pancreatitis.
Sixty consecutive patients were divided into enhanced recovery and traditional recovery (TR) groups in a randomized observational study. The basic enhanced recovery elements included early laparoscopic cholecystectomy, restrictive endoscopic intervention, and early oral nutrition. The incidence of complications, readmission, length of stay, and total medical cost were analyzed during the hospital course.
The length of hospital stay and medical cost were significantly lower in the enhanced recovery group in comparison to the TR group: 5.9 days vs. 10.6 days (P < 0.01) and ¥10,023 vs. ¥15,035 (P < 0.01). The complications and readmission rates in the two groups were similar.
The implementation of enhanced recovery protocols is feasible in the management of mild gallstone pancreatitis. The utilization of these protocols can achieve shorter hospital stays and reduced costs, with no increase in either the re-admission or peri-operative complication rates.
- Ramirez JM, Blasco JA, Rig JV, Maeso-Martinez S, Casal JE, Esteban F, et al. Enhanced recovery in colorectal surgery: a multicentre study. BMC Surg. 2011;11:9. CrossRef
- Arsalani-Zadeh R, ElFadl D, Yassin N, MacFie J. Evidence-based review of enhancing postoperative recovery after breast surgery. Br J Surg. 2011;98:181–96. CrossRef
- Ypsilantis E, Praseedom RK. Current status of fast-track recovery pathways in pancreatic surgery. JOP J Pancreas (Online). 2009;10(6):646–50.
- UK Working Party on Acute Pancreatitis. UK guidelines for the management of acute pancreatitis. Gut. 2005;54:1–9. CrossRef
- Banks PA, Freeman ML. Practice guidelines in acute pancreatitis. Am J Gastroenterol. 2006;101:2379–400. CrossRef
- Frossard JL, Steer ML, Pastor CM. Acute pancreatitis. Lancet. 2008;371:143–52. CrossRef
- Spanier BW, Dijkgraaf MG, Bruno MJ. Epidemiology, aetiology and outcome of acute and chronic pancreatitis: an update. Best Pract Res Clin Gastroenterol. 2008;22:45–63. CrossRef
- Neoptolemos JP. The theory of ‘persisting’ common bile duct stones in severe gallstone pancreatitis. Ann R Coll Surg Engl. 1989;71:326–31.
- Levy P, Boruchowicz A, Hastier P, Pariente A, Thevenot T, Frossard JL, et al. Diagnostic criteria in predicting a biliary origin of acute pancreatitis in the era of endoscopic ultrasound: multicentre prospective evaluation of 213 patients. Pancreatology. 2005;5:450–6. CrossRef
- Kimura Y, Arata S, Tadahiro T, Hirata K, Yoshida M, Mayumi T, et al. Gallstone-induced acute pancreatitis. J Hepatobiliary Pancreat Sci. 2010;17:60–9. CrossRef
- Rosing DK, de Virgilio C, Yaghoubian A, Putnam BA, El MM, Kaji A, et al. Early cholecystectomy for mild to moderate gallstone pancreatitis shortens hospital stay. J Am Coll Surg. 2007;205(6):762–6. CrossRef
- Sinha R. Early laparoscopic cholecystectomy in acute biliary pancreatitis: the optimal choice? HPB. 2008;10:332–5. CrossRef
- Horwood J, Akbar F, Davis K, Morgan R. Prospective evaluation of a selective approach to cholangiography for suspected common bile duct stones. Ann R Coll Surg Engl. 2010;92:206–10. CrossRef
- Freeman ML, Nelson DB, Sherman S, Haber GB, Herman ME, Dorsher PJ, et al. Complications of endoscopic biliary sphincterotomy. N Engl J Med. 1996;335:909–18. CrossRef
- Loperfido S, Angelini G, Benedetti G, Chilovi F, Costan F, De Berardinis F, et al. Major early complications from diagnostic and therapeutic ERCP: a prospective multicenter study. Gastrointest Endosc. 1998;48:1–10. CrossRef
- Vitale GC. Early management of acute gallstone pancreatitis. Ann Surg. 2007;245:18–9. CrossRef
- Shrode CW, Kahaleh M. Early ERCP in acute gallstone pancreatitis without cholangitis: a need for systematic biliary sphincterotomy! JOP. J Pancreas (Online). 2009;10(6):701–2. author reply 703–4.
- Oria A, Cimmino D, Ocampo C, Silva W, Kohan G, Zandalazini H, et al. Early endoscopic intervention versus early conservative management in patients with acute gallstone pancreatitis and biliopancreatic obstruction a randomized clinical trial. Ann Surg. 2007;245:10–7. CrossRef
- Acosta JM, Rubio GOM, Rossi R, Chinellato AV, Pellegrini CA. Effect of duration of ampullary gallstone obstruction on severity of lesions of acute pancreatitis. J Am Coll Surg. 1997;184:499–505.
- Acosta JM, Pellegrini CA, Skinner DB. Etiology and pathogenesis of acute biliary pancreatitis. Surgery. 1980;88:118–25.
- Acosta JM, Katkhouda N, Debian KA, Groshen SG, Tsao-Wei DD, Berne TV. Early ductal decompression versus conservative management for gallstone pancreatitis with ampullary obstruction: a prospective randomized clinical trial. Ann Surg. 2006;243:33–40. CrossRef
- Ioannidis O, Lavrentieva A, Botsios D. Nutrition support in acute pancreatitis. JOP. J Pancreas (Online). 2008;9(4):375–90.
- Meier R, Ockengab J, Pertkiewicz M, Pap A, Milinic N, MacFie J, et al. ESPEN guidelines on enteral nutrition: pancreas. Clin Nutr. 2006;25:275–84. CrossRef
- Enhanced recovery in the management of mild gallstone pancreatitis: a prospective cohort study
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Volume 43, Issue 6 , pp 643-647
- Cover Date
- Print ISSN
- Online ISSN
- Springer Japan
- Additional Links
- Enhanced recovery
- Acute gallstone pancreatitis
- Laparoscopic cholecystectomy
- Endoscopic retrograde cholangiopancreatography
- Industry Sectors
- Author Affiliations
- 1. Department of Hepatobiliary and Pancreatospleenic Surgery, Beijing Chaoyang Hospital Affiliated to Capital Medical University, Beijing, 100020, China