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

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Journal of Gastrointestinal Surgery Aims and scope

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.

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Abbreviations

ES:

endoscopic sphincterotomy

LOS:

length of hospital stay

CT:

computed tomography

ERCP:

endoscopic retrograde cholangiopancreatography

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Acknowledgment

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

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Authors and Affiliations

  1. Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA

    Kaori Ito, Hiromichi Ito & Edward E. Whang

Authors
  1. Kaori Ito
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  2. Hiromichi Ito
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  3. Edward E. Whang
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Correspondence to Edward E. Whang.

Additional information

Author contributions:

Conception and design: K. Ito, Whang

Acquisition of data: K. Ito, H. Ito

Analysis and interpretation of data: K. Ito, H. Ito, Whang

Drafting of the manuscript: K. Ito, Whang

Critical revision of the manuscript: K. Ito, H. Ito, Whang

Statistical expertise: K. Ito, H. Ito, Whang

Supervision: Whang

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Ito, K., Ito, H. & Whang, E.E. Timing of Cholecystectomy for Biliary Pancreatitis: Do the Data Support Current Guidelines?. J Gastrointest Surg 12, 2164–2170 (2008). https://doi.org/10.1007/s11605-008-0603-y

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