Timing of Cholecystectomy after Mild Biliary Pancreatitis: A Systematic Review

ObjectiveFollowing an episode of acute biliary pancreatitis, cholecystectomy is advised to prevent recurrent biliary events. There is limited evidence regarding the optimal timing and safety of cholecystectomy in patients with necrotising biliary pancreatitis.DesignA post hoc analysis of a multicentre prospective cohort. Patients with biliary pancreatitis and a CT severity score of three or more were included in 27 Dutch hospitals between 2005 and 2014. Primary outcome was the optimal timing of cholecystectomy in patients with necrotising biliary pancreatitis, defined as: the optimal point in time with the lowest risk of recurrent biliary events and the lowest risk of complications of cholecystectomy. Secondary outcomes were the number of recurrent biliary events, periprocedural complications of cholecystectomy and the protective value of endoscopic sphincterotomy for the recurrence of biliary events.ResultsOverall, 248 patients were included in the analysis. Cholecystectomy was performed in 191 patients (77%) at a median of 103 days (P25–P75: 46–222) after discharge. Infected necrosis after cholecystectomy occurred in four (2%) patients with persistent peripancreatic collections. Before cholecystectomy, 66 patients (27%) developed biliary events. The risk of overall recurrent biliary events prior to cholecystectomy was significantly lower before 10 weeks after discharge (risk ratio 0.49 (95% CI 0.27 to 0.90); p=0.02). The risk of recurrent pancreatitis before cholecystectomy was significantly lower before 8 weeks after discharge (risk ratio 0.14 (95% CI 0.02 to 1.0); p=0.02). The complication rate of cholecystectomy did not decrease over time. Endoscopic sphincterotomy did not reduce the risk of recurrent biliary events (OR 1.40 (95% CI 0.74 to 2.83)).ConclusionThe optimal timing of cholecystectomy after necrotising biliary pancreatitis, in the absence of peripancreatic collections, is within 8 weeks after discharge.

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Timing of Cholecystectomy After Mild Biliary Pancreatitis

Annals of Surgery ◽

10.1097/sla.0b013e3182507646 ◽

2012 ◽

Vol 255 (5) ◽

pp. 860-866 ◽

Cited By ~ 147

Author(s):

Mark C. van Baal ◽

Marc G. Besselink ◽

Olaf J. Bakker ◽

Hjalmar C. van Santvoort ◽

Alexander F. Schaapherder ◽

...

Keyword(s):

Biliary Pancreatitis ◽

Timing Of Cholecystectomy

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Optimal timing of cholecystectomy after necrotising biliary pancreatitis

Pancreatology ◽

10.1016/j.pan.2021.05.035 ◽

2021 ◽

Vol 21 ◽

pp. S11-S12

Author(s):

H. Timmerhuis ◽

N. Hallensleben ◽

R. Hollemans ◽

S. Pocornie ◽

J. van Grinsven ◽

...

Keyword(s):

Optimal Timing ◽

Biliary Pancreatitis ◽

Timing Of Cholecystectomy

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Timing of Cholecystectomy for Biliary Pancreatitis in Chinese Patients

Surgical Laparoscopy Endoscopy & Percutaneous Techniques ◽

10.1097/sle.0000000000000099 ◽

2015 ◽

Vol 25 (4) ◽

pp. 368-371

Author(s):

Haicheng Yuan ◽

Mingfang Qin ◽

Rong Liu ◽

Sanyuan Hu

Keyword(s):

Chinese Patients ◽

Biliary Pancreatitis ◽

Timing Of Cholecystectomy

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Timing of Cholecystectomy in Mild Acute Biliary Pancreatitis.

Albanian Journal of Trauma and Emergency Surgery ◽

10.32391/ajtes.v3i1.29 ◽

2019 ◽

Vol 3 (1) ◽

Author(s):

Orhan Alimoğlu ◽

Nuray Colapkulu ◽

Tunç Eren

Keyword(s):

Laparoscopic Cholecystectomy ◽

Hospital Stay ◽

Surgical Outcomes ◽

Gold Standard ◽

Definitive Treatment ◽

Biliary Pancreatitis ◽

Acute Biliary Pancreatitis ◽

Timing Of Cholecystectomy ◽

Safe Approach ◽

First Admission

Acute biliary pancreatitis (ABP) is one of the most common gastrointestinal events that requires acute admission to the hospital with considerable risks of mortality & morbidity. Laparoscopic cholecystectomy has become the gold standard for the treatment of ABP. Our aim was to determine the safety of cholecystectomy during the first admission by performing a review of the current literature. Waiting for 6 - 8 weeks to perform cholecystectomy may result with an increased incidence of recurrent ABP attacks, which may increase morbidity and the length of the hospital stay. On the contrary, cholecystectomy during the index admission for mild ABP appears to be a preferable and safe approach with better surgical outcomes providing a definitive treatment.

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Timing of cholecystectomy after percutaneous cholecystectomy for acute cholecystitis- A systematic review and meta-analysis

10.1101/2021.06.06.21258426 ◽

2021 ◽

Author(s):

BHAVIN VASAVADA ◽

Hardik Patel

Keyword(s):

Systematic Review ◽

Hospital Stay ◽

Biliary Tract ◽

Risk Ratio ◽

Meta Analysis ◽

Postoperative Mortality ◽

Mean Difference ◽

Complication Rates ◽

Percutaneous Cholecystostomy ◽

Timing Of Cholecystectomy

Introduction: There is a controversy about the optimum timing of cholecystectomy after percutaneous cholecystostomy. This systematic review and meta-analysis aimed to evaluate outcomes of early versus late cholecystectomy after percutaneous cholecystectomy. Methods: The study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and MOOSE guidelines. Heterogeneity was measured using Q tests and I2 statistics. The random-effects model was used. We evaluated cholecystectomy performed at different periods after percutaneous cholecystostomy within 72 hours or later, within or after one week or percutaneous cholecystostomy, within 10 days or after 10 days, less than 2 weeks or more than 2 weeks, less than 4 weeks or more than 4 weeks, less than 8 weeks or more than 8 weeks as per literature. Results: Six studies including 18640 patients were included in the final analysis. There was no difference in overall complications within or after 72 hours cholecystectomy group, but mortality and biliary complications were significantly high in the less than 72 hours group (p=0.05 and 0.0002 respectively). There was no difference in mortality, overall complication, biliary tract complications in less than 1 week versus more than 1 week and less than 10 days versus more than 10 days group. Overall complications were significantly less in the less than 2 weeks group compared to the more than 2 weeks group. There was no difference in mortality and biliary tract complications between less than 2 weeks and more than 2 weeks group. Overall complication rate (risk ratio 0.67, p <0.0001), postoperative mortality (risk ratio 0.46, p=0.003), bile duct injury (risk ratio 0.62, p=0.01) was significantly less in earlier than 4-week group. Hospital stay was not significantly different between less than 4 weeks versus more than 4 weeks group. (Mean difference= -2.74, p=0.12). Ove all complication rates were significantly more in less than 8 weeks group. (Risk ratio 1.07, p=0.01). Hospital stay was significantly less in less than 8 weeks group. (Mean difference 0.87, p=0.01). Conclusion: Early cholecystectomy preferably within 4 weeks after percutaneous cholecystostomy is preferable over late cholecystectomy.

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Timing of Cholecystectomy after Biliary Pancreatitis

10.1093/med/9780199384075.003.0046 ◽

2017 ◽

Author(s):

Michael P. Catanzaro ◽

Rachel J. Kwon

Keyword(s):

Hospital Admission ◽

Randomized Study ◽

Historical Study ◽

Evidence Based ◽

Biliary Pancreatitis ◽

Increased Risk ◽

History Of ◽

Timing Of Cholecystectomy ◽

Based Medicine ◽

Current Guidelines

This chapter provides a summary of a landmark historical study in surgery related to timing of cholecystectomy after biliary pancreatitis. It describes the history of the disease, a summary of the study including study design and results, and relates the study to a modern-day principle of evidence-based medicine: systematic reviews. This study was the first prospective randomized study to show that early removal of impacted gallstones did not prevent the progression of pancreatitis but did put patients at increased risk for other complications. Current guidelines, informed by this and subsequent studies, recommend that surgery be performed after pancreatic inflammation has subsided but ideally during the same hospital admission.

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