Timing of Cholecystectomy for Biliary Pancreatitis: Do the Data Support Current Guidelines?
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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.
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).
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].
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.
KeywordsBiliary pancreatitis Cholecystectomy Recurrent pancreatitis Endoscopic sphincterotomy
length of hospital stay
endoscopic retrograde cholangiopancreatography
The authors thank to Jan Rounds for her excellent secretarial assistance.
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