Early laparoscopic cholecystectomy in acute biliary pancreatitis: the optimal choice?

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Controversy over the timing of cholecystectomy in patients with acute biliary pancreatitis (ABP) still exists [ 1 x [1] Papi, C., Catarci, M., D'Ambrosio, L., Gilli, L., Koch, M., and Grassi, G.B. Early surgery for acute calculous cholecystitis is better than delayed. Am J Gastroenterol. 2004; 99: 147–155 Crossref | PubMed | Scopus (156) | Google Scholar See all References , 2 x [2] Herbert, F., Reuven, A.L.D., and Nathan, R. Gallstone pancreatitis. Arch Surg. 1976; 111: 1106–1107 Crossref | PubMed | Scopus (19) | Google Scholar See all References , 3 x [3] Ranson, J.H.C. The timing of biliary surgery in acute pancreatitis. Ann Surg. 1979; 189: 654–663 Crossref | PubMed | Scopus (232) | Google Scholar See all References , 4 x [4] Paloyan, D., David, S., and David, B.S.S. The timing of billiary tract operationson patients with pancreatitis associated with gallstones. Surg Gyn Obs. 1975; 141: 737–739 PubMed | Google Scholar See all References ]. Patients with severe ABP with associated dysfunction of multiple organs (MODS) are, unequivocally, logical choice for the initial conservative approach with interval laparoscopic cholecystectomy (ILC) 6–8weeks after the subsidence of the acute phase. The major determinant in favour of this approach has its origin partly in the associated high morbidity because of the surgical stress and anaesthetic complications. But patients with mild acute ABP, who incidentally form the major group (80%) in ABP [ 3 x [3] Ranson, J.H.C. The timing of biliary surgery in acute pancreatitis. Ann Surg. 1979; 189: 654–663 Crossref | PubMed | Scopus (232) | Google Scholar See all References , 5 x [5] McMahon, M.S., Playforth, M.S., and Pickford, I.R. A comaprative study of methods for the prediction of severity of attacks of acute pancreatitis. Br J Surg. 1980; 67: 22–25 Crossref | PubMed | Scopus (126) | Google Scholar See all References , 6 x [6] Tang, E., Steven, C., Tang, G., Eduardo, F., and Thomas, V. Timing of laparoscopic surgery in gallstone pancreatitis. Arch Surg. 1995; 130: 496–500 Crossref | PubMed | Scopus (78) | Google Scholar See all References , 7 x [7] Nealon, W.H., Bawduniak, J., and Walser, E.M. Appropriate timing of cholecystectomy in patients who present with moderate to severe gallstone – associated acute pancreatitis with peripancreatic fluid collections. Ann Surg. 2004; 23: 741–751 Crossref | Scopus (97) | Google Scholar See all References , 8 x [8] Tang, S.C., Stain, G., Tang, E.F., and Berne, T.V. Management of acute pancreatitis: from surgery to interventional intensive care. Gut. 2005; 54: 426–436 Crossref | PubMed | Scopus (227) | Google Scholar See all References ], do not have any associated organ dysfunction and thus are candidates who should be offered early laparoscopic cholecystectomy (ELC) during the first admission itself. This is all the more important to prevent a recurrent attack of acute pancreatitis, seen in as many as 30–50% of these patients during the waiting period for ILC [ 2 x [2] Herbert, F., Reuven, A.L.D., and Nathan, R. Gallstone pancreatitis. Arch Surg. 1976; 111: 1106–1107 Crossref | PubMed | Scopus (19) | Google Scholar See all References , 9 x [9] Soper, N.J., Brunt, L.M., Callery, M.P., Steven, A.E., and Giuseppe, A. Role of laparascopic cholecystectomy in the management of acute gallstone pancreatitis. Am J Surg. 1994; 167: 42–51 Abstract | Full Text PDF | PubMed | Scopus (55) | Google Scholar See all References , 10 x [10] Osborne, D.H., Imrie, C.W., and Carter, D.C. Biliary surgery in the same admission for gallstone associated acute pancreatitis. Br J Surg. 1981; 68: 758–761 Crossref | PubMed | Scopus (171) | Google Scholar See all References , 11 x [11] Tong, S. and Altkorn, D. Acute gallstone pancreatitis: how and when to intervene. Gut. 2005; 54: 426–436 Crossref | PubMed | Scopus (190) | Google Scholar See all References ] and also to reduce the number of defaulters. We set out to reassess the feasibility and the outcome of ELC, as compared to ILC, in patients with acute ABP. The results were also compared with those of patients with gallbladder calculus disease, without pancreatitis, who had elective LC.

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