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Journal of Gastrointestinal Surgery

, Volume 12, Issue 12, pp 2164–2170 | Cite as

Timing of Cholecystectomy for Biliary Pancreatitis: Do the Data Support Current Guidelines?

  • Kaori Ito
  • Hiromichi Ito
  • Edward E. Whang
original article

Abstract

Background

Current guidelines suggest that cholecystectomy be performed within 2 weeks after discharge following an episode of biliary pancreatitis. We hypothesized that a high incidence of gallstone-related events is present within 2 weeks after discharge prior to cholecystectomy.

Methods

Two hundred eighty-one patients who underwent cholecystectomy for biliary pancreatitis (January 1999–December 2005) were categorized into one of two groups: group A patients underwent cholecystectomy during index admission (n = 162), and group B patients underwent cholecystectomy following discharge from index admission (n = 119).

Results

Groups were comparable in demographics, comorbidities, and disease severity. Thirty-nine (32.8%) group B patients experienced pre-cholecystectomy gallstone-related events (including 16 cases of recurrent pancreatitis) after discharge. Recurrences (31.3%) occurred within 2 weeks after discharge. Endoscopic sphincterotomy protected against preoperative recurrent pancreatitis but was associated with a higher incidence of other gallstone-related events. Median total length of hospital stay was greater for group B than for group A [7 (range, 2–37) days vs. 5 (1–45) days, respectively, p = 0.00].

Conclusion

Current guidelines suggesting the appropriateness of waiting up to 2 weeks for cholecystectomy for biliary pancreatitis may place patients at unacceptably high risk for recurrence. Endoscopic sphincterotomy does not eliminate the risk of gallstone-related events.

Keywords

Biliary pancreatitis Cholecystectomy Recurrent pancreatitis Endoscopic sphincterotomy 

Abbreviations

ES

endoscopic sphincterotomy

LOS

length of hospital stay

CT

computed tomography

ERCP

endoscopic retrograde cholangiopancreatography

Notes

Acknowledgment

The authors thank to Jan Rounds for her excellent secretarial assistance.

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Copyright information

© The Society for Surgery of the Alimentary Tract 2008

Authors and Affiliations

  1. 1.Department of Surgery, Brigham and Women’s HospitalHarvard Medical SchoolBostonUSA

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