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01.12.2008 | original article | Ausgabe 12/2008

Journal of Gastrointestinal Surgery 12/2008

Timing of Cholecystectomy for Biliary Pancreatitis: Do the Data Support Current Guidelines?

Zeitschrift:
Journal of Gastrointestinal Surgery > Ausgabe 12/2008
Autoren:
Kaori Ito, Hiromichi Ito, Edward E. Whang
Wichtige Hinweise
Portions of this study were presented at the 3rd Annual Academic Surgical Congress, Huntington Beach, CA on February 14, 2008 and at the 42nd Annual Meeting of The Pancreas Club, San Diego, CA on May 18, 2008.
Author contributions:
Conception and design: K. Ito, Whang
Acquisition of data: K. Ito, H. Ito
Analysis and interpretation of data: K. Ito, H. Ito, Whang
Drafting of the manuscript: K. Ito, Whang
Critical revision of the manuscript: K. Ito, H. Ito, Whang
Statistical expertise: K. Ito, H. Ito, Whang
Supervision: Whang

Abstract

Background

Current guidelines suggest that cholecystectomy be performed within 2 weeks after discharge following an episode of biliary pancreatitis. We hypothesized that a high incidence of gallstone-related events is present within 2 weeks after discharge prior to cholecystectomy.

Methods

Two hundred eighty-one patients who underwent cholecystectomy for biliary pancreatitis (January 1999–December 2005) were categorized into one of two groups: group A patients underwent cholecystectomy during index admission (n = 162), and group B patients underwent cholecystectomy following discharge from index admission (n = 119).

Results

Groups were comparable in demographics, comorbidities, and disease severity. Thirty-nine (32.8%) group B patients experienced pre-cholecystectomy gallstone-related events (including 16 cases of recurrent pancreatitis) after discharge. Recurrences (31.3%) occurred within 2 weeks after discharge. Endoscopic sphincterotomy protected against preoperative recurrent pancreatitis but was associated with a higher incidence of other gallstone-related events. Median total length of hospital stay was greater for group B than for group A [7 (range, 2–37) days vs. 5 (1–45) days, respectively, p = 0.00].

Conclusion

Current guidelines suggesting the appropriateness of waiting up to 2 weeks for cholecystectomy for biliary pancreatitis may place patients at unacceptably high risk for recurrence. Endoscopic sphincterotomy does not eliminate the risk of gallstone-related events.

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