S36 Clinical Outcomes of Early vs Delayed Cholecystectomy in Patients With Mild Gallstone Pancreatitis: A Systematic Review and Meta-Analysis

Introduction: Gallstones are responsible for approximately 35%–40% of acute pancreatitis cases. While laparoscopic cholecystectomy is the standard treatment, the optimal timing of surgery remains controversial. This meta-analysis compares early vs delayed cholecystectomy in patients with mild gallstone pancreatitis, focusing on key clinical outcomes including hospital stay, readmission rates, and postoperative complications. Methods: A comprehensive literature search was conducted in PubMed, Scopus, and the Cochrane Library through May 2025. We compared early and delayed cholecystectomy in patients with mild gallstone pancreatitis. “Early cholecystectomy” was most commonly referred to as surgery performed during the index hospitalization or within a median of 3 days from admission. Primary outcomes included length of stay, readmission, perioperative and postoperative complications, duration of surgery, recurrent biliary events, and post-cholecystectomy ERCP requirements. A random-effects model was applied using Comprehensive Meta-Analysis Software (version 3). Results: Eighteen studies comprising 134,460 patients (11 randomized controlled trials and 7 observational studies) were included. Early cholecystectomy was associated with a significantly lower risk of recurrent biliary events (odds ratio [OR] = 0.065, P < 0.001), fewer postoperative complications (OR = 0.59, P < 0.001), and a shorter hospital stay (mean difference = –1.2 days; 95% CI: –1.758 to –0.656; P < 0.001). Conversely, it was associated with a higher likelihood of postoperative ERCP (OR = 1.67, P < 0.001). Outcomes such as conversion to open surgery, perioperative complications, and risk of readmission showed no significant differences between early and delayed cholecystectomy, with P-values of 0.246, 0.943, and 0.097, respectively. Furthermore, operation time was not significantly different between the 2 groups (95% CI: –0.187 to 0.791, P = 0.226). However, variability in definitions of “mild pancreatitis” across studies may affect generalizability. Conclusion: Early cholecystectomy in patients with mild gallstone pancreatitis is associated with superior clinical outcomes, including reduced hospital stay, lower postoperative complication rates, and fewer recurrent biliary events. Despite a higher likelihood of requiring postoperative ERCP, early intervention is preferred to improve patient outcomes and potentially reduce healthcare utilization. Standardized definitions and further high-quality studies are warranted to refine these findings.