Early versus Delayed Cholecystectomy in Mild Gallstone Pancreatitis (Prospective Comparative Study)

Abstract Background Gallstone pancreatitis is the most common etiology of acute pancreatitis accounting for up to sixty percent of all cases. In patients with mild gallstone pancreatitis – characterized by the absence of organ failure, peripancreatic fluid collections or necrosis, and typical resolution within one week – cholecystectomy is the definitive treatment. Aim of the Work To determine the feasibility of early cholecystectomy during index admission as long as the symptoms and laboratory values are improving for patients with gallstone pancreatitis predicted to be mild on admission and to obtain unbiased estimates of the effect of early cholecystectomy on hospital LOS, complications, and patient-reported outcomes (PROs) in order to determine the need for further evaluation. Patients and Methods This Prospective comparative study was conducted at tertiary care hospitals at Ain Shams University hospitals and Nasser institute for medical research and treatment from May 2022 till December 2022 and performed on a total of 20 adult patients who aged 18 years old and over with mild pancreatitis and without cholangitis. Results Patients treated with early or late procedure experienced approximately the same intra operative bleeding (30 vs 50%), conversion to open (10 vs 10%), biliary injury (0 vs 0%), and operation time (50 vs 50 minutes) with no statistically significant differences between them (p value= 1.00, 0.65, 0.912) respectively. Conclusion Early cholecystectomy after gallstone pancreatitis is more advantageous than late cholecystectomy after gallstone pancreatitis because it is associated with less rate of recurrence of biliary pancreatitis, less complication of pancreatitis, less perioperative complication (adhesions, blood loss, biliary events, infection, postoperative pain) and shorter duration of postoperative hospital stay.