Delayed cholecystectomy for gallstone pancreatitis: re-admissions and outcomes.
OBJECTIVE
Timing of cholecystectomy after gallstone pancreatitis and use of pre-operative cholangiography varies considerably between surgeons. We examined outcomes in a district general hospital where most patients underwent delayed cholecystectomy following pre-operative cholangiography.


METHODS
A retrospective review of admissions with gallstone pancreatitis over a 5-year period was conducted.


RESULTS
A total of 77 patients with gallstone pancreatitis were identified of whom 58 underwent laparoscopic cholecystectomy (LC) at a median of 67.5 days after index admission. Of these patients, 21% had unplanned re-admission while awaiting LC rising to 25% of those who waited for more than 4 weeks. Surgery at 4 weeks would have been associated with a 6% re-admission rate. Re-admissions were due to pancreatitis (4 cases), cholecystitis (3 cases), biliary colic (4 cases) and pseudocyst (1 case). In all, 49 patients had pre-operative cholangiography and 13 had pre-operative endoscopic extraction of stones from the common bile duct.


CONCLUSIONS
Delay of LC for greater than 4 weeks after gallstone pancreatitis is associated with a high, unplanned re-admission rate, even with liberal use of pre-operative cholangiography.
Cameron
Donald R
DR
Department of Surgery, Cheltenham General Hospital, Cheltenham, UK.
Goodman
Anthony J
AJ
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods; D017081:Cholecystectomy, Laparoscopic / Q000379:methods* / Q000706:statistics & numerical data; D041761:Cholecystolithiasis / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000209:etiology / Q000601:surgery*; D010359:Patient Readmission; D011300:Preoperative Care / Q000379:methods; D012086:Reoperation; D012189:Retrospective Studies; D016717:Sphincterotomy, Endoscopic / Q000379:methods / Q000706:statistics & numerical data; D013997:Time Factors; D016896:Treatment Outcome