Early or Delayed Cholecystectomy in Acute Gallstone Pancreatitis

Abstract

Introduction Acute biliary pancreatitis is one of the most common gastrointestinal illnesses necessitating inpatient hospital admission. With an increasing incidence of gallstone disease, in the setting of a changing healthcare landscape, surgical indications must be carefully examined. The principles of management, including common duct clearance, bowel rest, and interval cholecystectomy to avoid recurrent disease have not changed, however with the refinement of minimally invasive techniques, timing of intervention deserves re-examination. We seek to make evidence based recommendations on the timing of cholecystectomy following acute biliary pancreatitis. Methods OVID Medline, EMBASE, and Cochrane Review databases were queried in systematic fashion for English language articles published after 1994 using ``Cholecystectomy, laparoscopic{''} and ``Pancreatitis{''}. To be included, studies must state a laparoscopic success rate, morbidity, and mortality. Studies not classifying severity of pancreatitis (or mixing mild and severe patients), those with fewer than ten patients, and those not identifying time until laparoscopic cholecystectomy were excluded. Identified articles were examined for relevance. Results Four hundred sixty-two unique publications were identified. Nine met inclusion criteria and were subsequently included in analysis. Eight were retrospective studies. One prospective randomized trial was identified and included. Conclusions Management recommendations are made based on severity of pancreatitis. For patients with mild, stable pancreatitis, we make a strong recommendation for laparoscopic cholecystectomy at the earliest convenience. In patients with severe pancreatitis, there is insufficient evidence to make a recommendation for an appropriate interval for laparoscopic cholecystectomy, however patients should be considered for endoscopic sphincterotomy as a bridging procedure.