Timing of Cholecystectomy in Mild Acute Biliary Pancreatitis.

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 for Acute Biliary Pancreatitis

Bangabandhu Sheikh Mujib Medical University Journal ◽

10.3329/bsmmuj.v1i1.3690 ◽

2009 ◽

Vol 1 (1) ◽

pp. 11

Author(s):

M Mohsen Chowdhury

Keyword(s):

Hospital Stay ◽

Definitive Treatment ◽

Amylase Level ◽

Biliary Pancreatitis ◽

Biliary Stones ◽

Acute Biliary Pancreatitis ◽

Group I ◽

Timing Of Cholecystectomy ◽

Group Ii ◽

First Admission

Background : Biliary stones are the leading cause of acute pancreatitis. Although cholecystectomy and selective endoscopic retrograde cholangiography (ERC) comprise the current treatment in patients with acute biliary pancreatitis (ABP), the time of intervention is still controversial. Objective : In this study the outcomes of cholecystectomy was evaluated. Methods : on first admission for ABP and in patients with recurrent biliary pancreatitis. A series of 45 patients with ABP between January 2003 and November 2008 were evaluated retrospectively. Patients were classified into two groups. Group I included 30 patients who underwent cholecystectomy on first admission before discharge from the hospital. Group II comprised of 15 patients who had recurrent biliary pancreatitis and then underwent cholecystectomy. The severity of the pancreatitis was determined by Ranson's criteria. Age, gender, length of hospital stay, severity of pancreatitis, amylase level, and complications of cholecystectomy were evaluated in both groups. Patients in group I underwent cholecystectomy during the first hospital admission and patients in group II during an admission for a recurrence. Results: there were 24 patients with a Ranson's score 3 in group I and 12 in group II. The mean hospital stays were 15.29 days (range 4-48 days) and 36.66 days (range 15-123 days) in groups I and II, respectively (p = 0.006). Morbidity was 11% without mortality in group I and 43% with one mortality in group II (p = 0.023). Conclusions: Definitive treatment of ABP can be accomplished effectively and safely by cholecystectomy following clinical improvement, with selective ERC performed during the first admission (delayed cholecystectomy). Waiting to perform cholecystectomy (interval cholecystectomy) may result in recurrent biliary pancreatitis, which may increase morbidity and the length of the hospital stay. Key words : Timing of cholecystectomy, acute biliary pancreatitisDOI: 10.3329/bsmmuj.v1i1.3690 BSMMU J 2008; 1(1): 11-14

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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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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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MILD TO MODERATE ACUTE BILIARY PANCREATITIS;

The Professional Medical Journal ◽

10.29309/tpmj/2014.21.03.2028 ◽

2014 ◽

Vol 21 (03) ◽

pp. 519-523

Author(s):

Muhammad Sohaib Khan ◽

Jahangir Sarwar Khan ◽

Muhammad Mussadiq Khan

Keyword(s):

Laparoscopic Cholecystectomy ◽

Hospital Admission ◽

Conversion Rate ◽

Statistical Significance ◽

Open Cholecystectomy ◽

Definitive Treatment ◽

Biliary Pancreatitis ◽

Acute Biliary Pancreatitis ◽

Male Patients ◽

Index Hospital

Introduction: Acute biliary pancreatitis is a serious complication of biliarycalculous disease and is associated with significant morbidity and mortality. Incidence is moreoften in females and cause is the gall stones in majority of the cases. Definitive treatment ischolecystectomy and with the advancement of minimal invasive surgery, laparoscopiccholecystectomy has been considered as a gold standard for the management of acute BiliaryPancreatitis. The optimal timing when to perform laparoscopic cholecystectomy is still underdebate. Many surgeons recommend early surgery whereas others are in favor of delayedsurgery. This study is carried out to compare the timing of laparoscopic cholecystectomy in casesof acute biliary pancreatitis. Objective: To compare the frequency of conversion fromlaparoscopic to open cholecystectomy in early versus delayed laparoscopic cholecystectomy inmild to moderate acute biliary pancreatitis. Study design: Randomised Control trial (RCT).Setting: Department of surgery, Holy Family Hospital, Rawalpindi. Duration: Six months, fromJanuary 2010 to June 2012. Material and methods: 306 patients, diagnosed as mild tomoderate acute Biliary Pancreatitis were randomly allocated into two groups for laparoscopiccholecystectomy. Those who were operated within two weeks of index hospital admission werelabeled as Early laparoscopic cholecystectomy (EC) group whereas those undergoing surgeryafter 02 weeks of index hospital admission were considered as Delayed laparoscopiccholecystectomy group(DC). Conversion rate from laparoscopic to open cholecystectomy wascompared in two groups. Results: Out of 153 patients enrolled as EC group, 138 were female and15 were male patients. Mean age was 39.19 ± 11.25years where as in DC group , there were 134female and 19 male patients in a total of 153 patients, and the mean age was 39.54 ±10.37 years.Conversion from laparoscopic surgery to open cholecystectomy was 8.5%(13 patients) and13.1%(20 patients) in EC and DC groups respectively. The overall conversion rate was 10.8%.There was no statistical significance between conversion rate of the two groups. (p = 0.197)Conclusions: Acute Biliary Pancreatitis should be managed by laparoscopic cholecystectomyregardless of the time elapsed since the start of symptoms. There is no statistical significance ofconversion rate from laparoscopic to open cholecystectomy associated with the timing ofsurgical intervention in the case of acute Biliary Pancreatitis.

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Timing of Cholecystectomy for Acute Biliary Pancreatitis: Outcomes of Cholecystectomy on First Admission and after Recurrent Biliary Pancreatitis

World Journal of Surgery ◽

10.1007/s00268-002-6647-3 ◽

2003 ◽

Vol 27 (3) ◽

pp. 256-259 ◽

Cited By ~ 45

Author(s):

Orhan Alimoglu ◽

Orhan V. Ozkan ◽

Mustafa Sahin ◽

Adem Akcakaya ◽

Ramazan Eryilmaz ◽

...

Keyword(s):

Biliary Pancreatitis ◽

Acute Biliary Pancreatitis ◽

Timing Of Cholecystectomy ◽

First Admission

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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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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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Early same-admission laparoscopic cholecystectomy for acute mild biliary pancreatitis: a retrospective study

10.21203/rs.2.16767/v1 ◽

2019 ◽

Author(s):

yunxiao lyu ◽

Yunxiao Cheng ◽

Bin Wang

Keyword(s):

Laparoscopic Cholecystectomy ◽

Hospital Stay ◽

Optimal Time ◽

Control Group ◽

Biliary Pancreatitis ◽

Group I ◽

Estimated Blood Loss ◽

Conversion To Open Cholecystectomy ◽

Duration Of Surgery ◽

Group Ii

Abstract Background As the standard procedure for the surgical treatment for gallbladder stones, we investigated the controversy surrounding the optimal time for laparoscopic cholecystectomy (LC) for acute mild biliary pancreatitis.Methods This retrospective study included medical records of all patients who were admitted with a diagnosis of acute mild biliary pancreatitis at Dongyang People’s Hospital from July 2011 to June 2018. Main outcomes included perioperative characteristics, length of hospital stay, complications, morbidity, and mortality.Results A total of 119 patients were divided into an early LC group (Group I; 52 patients) and a control group (Group II; 67 patients). The mean age was 60.5 years (range, 30–79 years). Conversion to open cholecystectomy (COC) was performed in 17 patients (6 patients in Group I and 11 patients in Group II, P=0.62). There were no significant differences in terms of estimated blood loss and duration of surgery (P=0.08 and P=0.64, respectively). Bile duct injury (BDI) occurred in one patient from each group. The overall hospital stays in Group I were significantly less than in Group II (10.86±3.21 vs 13.29±4.51, P=0.001). Compared with postoperative bile leakage (P=0.72) and postoperative morbidity (P=0.97) and mortality, there were no significant differences between the groups.Conclusions Early LC during the same admission is safe for acute mild biliary pancreatitis and has the advantage of shortening overall hospital stay. There was no significant increase in COC, BDI, and complications.

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