Early Versus Delayed Laparoscopic Cholecystectomy in Mild Acute Biliary Pancreatitis. A Comparative Study

The objective was to improve the management of patients with acute biliary pancreatitis against the background of cholecystocholedocholithiasis.Methods and materials. 107 patients with acute biliary pancreatitis against the background of cholecystocholedocholithiasis were treated between 2017 and 2020 years. Patients suffering from mild and moderately severe acute biliary pancreatitis underwent single-step (laparoscopic cholecystectomy with endoscopic papillosphincterotomy) or two-step (endoscopic papillosphincterotomy with delayed laparoscopic cholecystectomy) surgical interventions. Patients with severe acute pancreatitis underwent endoscopic papillosphincterotomy with or without common bile duct and pancreatic duct stenting. The comparative analysis was made to estimate the efficiency of different surgical interventions in different groups of patients.Results. Patients with mild or moderately severe acute biliary pancreatitis showed better outcomes after single-step surgical intervention. Patients with severe acute biliary pancreatitis – after endoscopic papillosphincterotomy with common bile duct and pancreatic duct stenting.Conclusion. Single-step surgical interventions (laparoscopic cholecystectomy with endoscopic papillosphincterotomy) are shown for patients with mild or moderately severe acute biliary pancreatitis, because this approach helps to preserve the complications, specific for two-step interventions. The single-step approach authentically helps to decrease the duration of hospital stay and reduce treatment costs. The two-step approach is shown for patients with severe acute biliary pancreatitis, but endoscopic papillosphincterotomy with lithoextraction should be supplemented by common bile duct and pancreatic duct stenting, in order to reduce the number of complications associated with delayed cholecystectomy.

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Effect of operation timing on efficacy of laparoscopic cholecystectomy combined with endoscopic sphincterotomy for patients with mild acute biliary pancreatitis

World Chinese Journal of Digestology ◽

10.11569/wcjd.v23.i12.1980 ◽

2015 ◽

Vol 23 (12) ◽

pp. 1980

Author(s):

Bi-Hui Yin

Keyword(s):

Laparoscopic Cholecystectomy ◽

Endoscopic Sphincterotomy ◽

Biliary Pancreatitis ◽

Acute Biliary Pancreatitis ◽

Operation Timing

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Early versus Delayed Single-Stage Laparoscopic Eradication for Both Gallstones and Common Bile Duct Stones in Mild Acute Biliary Pancreatitis

The American Surgeon ◽

10.1177/000313480507100812 ◽

2005 ◽

Vol 71 (8) ◽

pp. 682-686 ◽

Cited By ~ 9

Author(s):

John Griniatsos ◽

Evangelos Karvounis ◽

Alberto Isla

Keyword(s):

Laparoscopic Cholecystectomy ◽

Bile Duct ◽

Common Bile Duct ◽

Single Stage ◽

Definitive Treatment ◽

Morbidity Rate ◽

Biliary Pancreatitis ◽

Acute Biliary Pancreatitis ◽

Laparoscopic Management ◽

Significant Difference

Several studies addressed that preoperative endoscopic retrograde cholangiopancreatography (ERCP) for common bile duct (CBD) clearance, followed by interval laparoscopic cholecystectomy (two-stage approach), constitutes the most common practice in cases of uncomplicated mild acute biliary pancreatitis. Between June 1998 and December 2002, 44 patients (35 females and 9 males with a median age of 62 years) suffering from uncomplicated mild acute biliary pancreatitis were treated in our unit. All patients were electively submitted to surgery after subsidence of the acute symptoms, and for definitive treatment we favored the single-stage laparoscopic management, avoiding preoperative ERCP. All patients underwent laparoscopic cholecystectomy plus fluoroscopic intraoperative cholangiogram (IOC). If filling defect(s) were detected in the IOC, a finding suggestive of concomitant choledocholithiasis, laparoscopic common bile duct exploration (LCBDE) was added in the same sitting. Twenty patients were operated upon within 2 weeks since the attack of the acute symptoms and constitute the early group (n = 20), whereas 24 patients underwent an operation later on and constitute the delay group (n = 24). We retrospectively compare the safety, effectiveness, and outcome after the single-stage laparoscopic management between the two groups of patients. Laparoscopic cholecystectomy alone constituted the definitive treatment in 38 patients, while an additional LCBDE was performed in the remaining 6 patients (14%), and all operations were achieved laparoscopically. There was no statistically significant difference between the groups in terms of operative time, incidence of concomitant choledocholithiasis, morbidity rate, and postoperative hospital stay. During the follow-up, none of the patients experienced recurrent pancreatitis. In uncomplicated mild acute biliary pancreatitis cases, a single-stage definitive laparoscopic management, avoiding preoperative ERCP, can be safely performed during the same admission, after the improvement of symptoms and local inflammation. Postoperative ERCP should be selectively used in patients in whom the single-stage method failed to resolve the problem.

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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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Index Admission Laparoscopic Cholecystectomy, Our Experience after the Inception of Acute Care Surgery Programme

10.21203/rs.3.rs-32690/v1 ◽

2020 ◽

Author(s):

Muhammad Aakif ◽

Zeeshan Razzaq ◽

James Byrne ◽

Hamid Mustafa ◽

Mudassar Majeed ◽

...

Keyword(s):

Laparoscopic Cholecystectomy ◽

Acute Cholecystitis ◽

Length Of Hospital Stay ◽

Index Admission ◽

Acute Care Surgery ◽

Biliary Colic ◽

Biliary Pancreatitis ◽

Acute Biliary Pancreatitis ◽

Symptomatic Disease ◽

Care Surgery

Abstract Background: Gallstones are very common and frequently present as acute cholecystitis in up to 20 % of patients with symptomatic disease, with wide variation in severity. Laparoscopic Cholecystectomy (LC) has become the gold standard for treatment of symptomatic disease. Although multiple studies have confirmed its safety, LC at index admission is still not widely practiced in Ireland. We present our experience of a cohort of patients who underwent index admission laparoscopic cholecystectomy at Cork University Hospital since the start of the acute care surgery program in May 2017.Aim: To determine the feasibility and safety of laparoscopic cholecystectomy at index admission.Methods: All adult patients who presented to an acute surgical assessment unit (ASAU) with symptomatic gall stone disease and underwent early laparoscopic cholecystectomy at index admission were included. The duration of this prospective cohort study was 27 months (May 2017 to July 2019). Patient demographics, indication for surgery, post-operative complications and conversion rates were recorded. In addition, timing of imaging, imaging findings and length of hospital stay were also noted.Results: A total of 233 patients underwent laparoscopic Cholecystectomy at index admission for various indications. Median age was 50 years with range between 16 - 88. Male to female ratio was 1: 1.78. 142 (61%) patients had acute cholecystitis, while the other indications were CBD obstruction (15.5%), biliary colic (11%) and acute biliary pancreatitis (10.5%). 93 (40%) patients had pre-op MRCP while 41 (17.6%) underwent pre-op ERCP. All except 3 patients undergoing ERCP had pre-procedure MRCP. 2 patients had intra-operative cholangiograms. Overall morbidity was 4.7%. In terms of complications, 3 (1.3%) patients had bile leak and only 1 (0.85%) had re-operation. There was 1 common bile duct injury and only 1 conversion to open surgery. There was no mortality in this case series. The average length of hospital stay was 5.6 days. (Range 2 to 14 days).Conclusions: Index admission laparoscopic cholecystectomy for acute cholecystitis, choledocholithiasis, biliary colic and acute biliary pancreatitis, has been a safe and feasible treatment option in our hospital. A safe practice can be ensured by adherence to this care pathway and a multidisciplinary, consultant-led service. Index cholecystectomy service can be provided safely to reduce disease-related morbidity and multiple re-admissions in patients awaiting interval surgery.

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Laparoscopic Cholecystectomy in Patients with Mild Acute Biliary Pancreatitis

Lviv clinical bulletin ◽

10.25040/lkv2016.023.051 ◽

2016 ◽

Vol 2-3 (14-15) ◽

pp. 51-54 ◽

Cited By ~ 1

Author(s):

A. Reiti ◽

◽

A. Golovin ◽

I. Yatsyk

Keyword(s):

Laparoscopic Cholecystectomy ◽

Biliary Pancreatitis ◽

Acute Biliary Pancreatitis

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Interval Laparoscopic Cholecystectomy in the Management of Acute Biliary Pancreatitis

HPB Surgery ◽

10.1155/2000/40290 ◽

2000 ◽

Vol 11 (5) ◽

pp. 319-323 ◽

Cited By ~ 22

Author(s):

M. D. Pinhas Schachter ◽

M. D. Timor Peleg ◽

M. D. Oded Cohen

Keyword(s):

Acute Pancreatitis ◽

Laparoscopic Cholecystectomy ◽

Traditional Approach ◽

Open Cholecystectomy ◽

Gallbladder Disease ◽

Operating Time ◽

Biliary Pancreatitis ◽

Acute Biliary Pancreatitis ◽

Calot’S Triangle ◽

Mild Acute Pancreatitis

The timing of laparoscopic cholecystectomy following an attack of acute biliary pancreatitis is controversial. The traditional approach of interval cholecystectomy has been challenged recently. The present study was designed to evaluate the benefits of interval laparoscopic cholecystectomy for patients with mild acute pancreatitis (Ranson less than 3). Nineteen patients with mild pancreatitis underwent ultrasonographic evaluation to confirm the biliary etiology. ERCP was performed in all patients on the first available endoscopy list, and endoscopic sphincterotomy was performed in two patients with calculi or dilated common bile duct on ultrasonographic examination. Medical treatment was administered and laparoscopic cholecystectomy was scheduled after 8–12 weeks to allow the inflammatory process to settle. There were no recurrent attacks of pancreatitis during this period. The degree of difficulty of the laparoscopic procedure was assessed by the presence of adhesions to the gallbladder area, difficulty of dissection in the Calot's triangle, intraoperative bleeding and the need for a drain. Six patients (31.5%) had severe adhesions, difficult dissection of the cystic duct and artery, bleeding and prolonged operating time. In two of these patients (10.5%) the procedure was converted to open cholecystectomy. In conclusion, our results suggest that postponing laparoscopic cholecystectomy in acute pancreatitis patients is not advantageous surgically and does not justify the risk of further morbidity caused by the gallbladder disease.

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Laparoscopic cholecystectomy in acute biliary pancreatitis

Turkish Journal of Surgery ◽

10.5097/1300-0705.ucd.1019-11.02 ◽

2011 ◽

Vol 27 (3) ◽

pp. 141

Author(s):

Mustafa Girgin ◽

Ahmet Turkoglu ◽

Refik Ayten ◽

Ziya Cetinkaya ◽

Mustafa Mulla ◽

...

Keyword(s):

Laparoscopic Cholecystectomy ◽

Biliary Pancreatitis ◽

Acute Biliary Pancreatitis

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Gall Stones in Acute Pancreatitis - A Prospective Study

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2020/553 ◽

2020 ◽

Vol 7 (46) ◽

pp. 2690-2693

Author(s):

Venkata Prakash Gandikota ◽

Tharaka Mourya Nutulapati ◽

Purushotham Gangapalli ◽

Ajay Babu Korchapati ◽

Sahithi Priya Boddukura ◽

...

Keyword(s):

Acute Pancreatitis ◽

Laparoscopic Cholecystectomy ◽

Prospective Study ◽

Hospital Stay ◽

Morbidity And Mortality ◽

Care Hospital ◽

Biliary Pancreatitis ◽

Acute Biliary Pancreatitis ◽

Gall Stones ◽

A Prospective Study

BACKGROUND Multiple practice guidelines from different American and European societies recommend index hospitalization cholecystectomy following an episode of gallstone pancreatitis. We wanted to analyse the outcome of patients presenting with acute pancreatitis in the presence of gall stones, analyse the sensitivity and specificity of liver function tests in early prediction of acute biliary pancreatitis and establish the advantages of early intervention in acute biliary pancreatitis. METHODS This is a prospective study conducted at a tertiary care hospital for a period of 12 months among 100 cases of acute pancreatitis who presented with abdominal pain with serum amylase level 3 times the normal limits in the absence of hypercalcemia or hyperlipidaemia. Presence of gallstones was confirmed on ultrasonography. Patients were subjected to preoperative ERCP and endoscopic sphincterotomy. Intraoperative and postoperative morbidity and mortality, and postoperative hospital stay were reported. RESULTS Gall stones were the cause of pancreatitis in 16 out of 100 cases (16 %). Male to female ratio was 1 : 3. Mean occurrence of age was 51.1 years. Preoperative ERCP was done 10 cases (63 %). Laparoscopic Cholecystectomy was performed in all the 16 cases (100 %) of which 12 cases (75 %) underwent Lap cholecystectomy in the same admission and 4 cases were subjected to interval cholecystectomy. 1 case was converted to open procedure. Post-operative complications include nausea and vomiting in 2 cases, chest infection in 2 and bile leak in 1. CONCLUSIONS Management of acute pancreatitis in the presence of gallstones requires prompt diagnosis and timely intervention. Laparoscopic cholecystectomy can be safely performed for mild to moderate acute biliary pancreatitis after clinical and biochemical resolution of the attack during the same admission with acceptable morbidity and mortality rates. This strategy will lead to reducing the recurring acute biliary pancreatitis, number of admissions and hospital stay. KEYWORDS Acute Pancreatitis, Gallstones, LFT, Lipase, Amylase, ERCP, Laparoscopic Cholecystectomy

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