ASSESSMENT OF THE EARLY AND DELAYED CHOLECYSTECTOMY IN PATIENTS WITH ACUTE BILIARY PANCREATITIS

Main Article Content

Swetha Sakthivel
Ayesha Hanif
Muhammad Mohsin Mansoor
Inshaal Khalid
Abdullah Ahmed Almesri
Iqra Zulfiqar

Keywords

Acute biliary pancreatitis, early cholecystectomy, late cholecystectomy

Abstract

Background and Aim: Gallstone-related pancreatitis is a frequently encountered complication. Majority of individuals suffer from mild disease but progress to severe pancreatitis in 20% cases, elevating the likelihood of significant complications in recurring episodes. The present study aimed to compare the early versus delayed cholecystectomy in acute biliary pancreatitis patients.


Patients and Methods:  A prospective randomized study was carried out on 80 acute biliary pancreatitis patients in the general surgery wards of several tertiary units in the United Kingdom from April 2022 to December 2022. De-identified patient data was obtained in this multi-centric study. Patients were categorized into two groups; Group-A (early cholecystectomy) and Group-B (late cholecystectomy). Peri-operative complications, surgery duration, recurrent biliary events, conversion rate, and total hospital stay were evaluated and compared in both groups. SPSS version 27 was used for descriptive statistics.


Results: The overall mean age of group-A and group-B was 40.82±14.62 and 46.38±16.64 years respectively. Majority of patients belonged to 31 to 50 years (35% (n=14) in early vs. 32.5% (n=13) in late group). Abdomen pain was the most prevalent presented complaint 100% (n=40) found in both groups. The pre and post-operative laboratory parameters such as ALT, ALP, and total bilirubin in early vs. late were 41.05±15.82 vs. 32.71±16.98, 182.42±62.63 vs. 112.06±18.72, and 1.05±0.58 vs. 0.64±0.14 respectively. About 80% (n=32) patients of early cholecystectomy took 60 to 75 minutes for intervention as compared to 75% (n=30) patients of late cholecystectomy 75 to 90 minutes. Mean hospital stay of early and late cholecystectomy group was 7.49±2.69 and 15.42±6.64 days respectively.


Conclusion: Early cholecystectomy significantly minimize the duration of surgery, risk of postoperative complications, recurrent biliary events, duration of surgery, and hospital stay in acute biliary pancreatitis as compared to late cholecystectomy.

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References

1. Chandak U, Pind V, Mitra A, Bansod PY, Gaikwad U, Ramteke P. Early versus late laparoscopic cholecystectomy in acute biliary pancreatitis: a prospective randomised study. Int Surg J 2022;9:1558-1565.
2. Saritaş Ü, Üstündağ Y. Endoscopic retrograde cholangiopancreatography in acute biliary pancreatitis. In: recent advances in pancreatitis. India: Intech Open; 2021.
3. Jee SL, Jarmin R, Lim KF, Raman K. Outcomes of early versus delayed cholecystectomy in patients with mild to moderate acute biliary pancreatitis: a randomized prospective study. Asian J Surg. 2018;41(1):47-54
4. UK guidelines for the management of acute pancreatitis. Available at: https://gut.bmj.com/.Accessed on 20 October 2021.
5. Vege SS, DiMagno MJ, Forsmark CE, Martel M, Barkun AN. Initial medical treatment of acute pancreatitis: American gastroenterological association institute technical review. Gastroenterology. 2018; 154(4):1103-39.
6. Cho JH, Kim TN, Kim SB. Comparison of clinical course and outcome of acute pancreatitis according to the two main etiologies: alcohol and gallstone. BMC Gastroenterol. 2015;15:87.
7. Zilio MB, Eyff TF, Azeredo-Da-Silva ALF, et al. A systematic review and meta-analysis of the aetiology of acute pancreatitis. HPB (Oxford). 2019;21:259–67
8. Dubina ED, de Virgilio C, Simms ER, et al. Association of early vs delayed cholecystectomy for mild gallstone pancreatitis with perioperative outcomes. JAMA Surg. 2018;153:1057–9.
9. Degrate L, Bernasconi DP, Meroni P, et al. Mild acute biliary pancreatitis: the timing of cholecystectomy should not exceed index admission. Minerva Chir. 2017;72:383–90.
10. Zhong FP, Wang K, Tan XQ, et al. The optimal timing of laparoscopic cholecystectomy in patients with mild gallstone pancreatitis: a meta-analysis. Medicine (Baltim). 2019;98:e17429.
11. Rios-Diaz AJ, Lamm R, Metcalfe D, et al. National recurrence of pancreatitis and readmissions after biliary pancreatitis. Surg Endosc. 2022;36:7399–408.
12. Mueck KM, Wei S, Pedroza C, et al. Gallstone pancreatitis: admission versus normal cholecystectomy-a randomized trial (Gallstone PANC Trial). Ann Surg. 2019;270:519–27.
13. Bougard M, Barbier L, Godart B, et al. Management of biliary acute pancreatitis. J Visc Surg. 2019;156:113–25.
14. Dai W, Zhao Y, Du GL, et al. Comparison of early and delayed cholecystectomy for biliary pancreatitis: a meta-analysis. Surgeon. 2021;19:257–62.
15. Prasanth J, Prasad M, Mahapatra SJ, Krishna A, Prakash O, Garg PK, Bansal VK. Early versus delayed cholecystectomy for acute biliary pancreatitis: a systematic review and meta-analysis. World Journal of Surgery. 2022 Jun;46(6):1359-75.
16. Dadhwal US. Early Versus Delayed Cholecystectomy for Acute Biliary Pancreatitis: A Systematic Review and Meta-Analysis. World Journal of Surgery. 2022 Oct;46(10):2539-40.
17. Riquelme F, Marinkovic B, Salazar M et al Early laparoscopic cholecystectomy reduces hospital stay in mild gallstone pancreatitis. A randomized controlled trial. HPB (2020) 22:26–33.
18. Mueck KM, Wei S, Pedroza C et al Gallstone pancreatitis: admission versus normal cholecystectomy—a randomized trial (gallstone PANC Trial). Ann Surg (2019) 270:519–527
19. Noel R, Arnelo U, Lundell L et al Index versus delayed cholecystectomy in mild gallstone pancreatitis: results of a randomized controlled trial. HPB (2018) 20:932–938.
20. Davoodabadi A, Beigmohammadi E, Gilasi H et al Optimizing cholecystectomy time in moderate acute biliary pancreatitis: a randomized clinical trial study. Heliyon (2020) 6:e03388.
21. Omar MA, Hamed MN Acute biliary pancreatitis—optimal time for cholecystectomy: a prospective randomized study. Gen Surg (2018) 3:7.
22. Abou-Sheishaa MS, Burham WA, Abbas AE et al When to do laparoscopic cholecystectomy in mild acute biliary pancreatitis, Early or Late? Ann Emerg Surg (2018) 3(1):1031.
23. Moody N, Adiamah A, Yanni F et al Meta-analysis of randomized clinical trials of early versus delayed cholecystectomy for mild gallstone pancreatitis. Br J Surg (2019) 106:1442–1451.
24. Dai W, Zhao Y, Du GL, Zhang RP. Comparison of early and delayed cholecystectomy for biliary pancreatitis: a meta-analysis. The Surgeon. 2021 Oct 1;19(5):257-62.
25. Lyu YX, Cheng YX, Jin HF, Jin X, Cheng B, Lu D. Same-admission versus delayed cholecystectomy for mild acute biliary pancreatitis: a systematic review and meta-analysis. BMC surgery. 2018 Dec;18:1-0.
26. Di Martino M, Ielpo B, Pata F, Pellino G, Di Saverio S, Catena F, De Simone B, Coccolini F, Sartelli M, Damaskos D, Mole D. Timing of cholecystectomy after moderate and severe acute biliary pancreatitis. JAMA surgery. 2022 Oct 1;158(10):e233660-.
27. Lyu Y, Ye S, Wang B. Outcomes of delayed versus early endoscopic intervention for acute biliary pancreatitis with non-severe acute cholangitis. BMC surgery. 2022 Dec 26;22(1):440.
28. Abbas MH, Niazi NA, Nazir M. Acute Biliary-Pancreatitis: is early Cholecystectomy Safe?. Pakistan Journal of Medical & Health Sciences. 2022 Apr 29;16(04):48-.
29. Hussain M, Alam J, Ullah M, Zahid MJ, Wahid U. Outcomes of Early Vs. Delayed Laparoscopic Cholecystectomy in Acute Biliary Stone-Induced Pancreatitis a Prospective Observational Study. Pakistan Journal of Medical & Health Sciences. 2022 Mar 12;17(01):704.
30. Discolo A, Reiter S, French B, Hayes D, Lucas G, Tan L, Scanlan J, Martinez R. Outcomes following early versus delayed cholecystectomy performed for acute cholangitis. Surgical endoscopy. 2020 Jul;34:3204-10.

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