Timing of cholecystectomy for biliary pancreatitis: do the data support current guidelines?
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].


CONCLUSIONS
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.
Ito
Kaori
K
Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
Ito
Hiromichi
H
Whang
Edward E
EE
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002763:Cholecystectomy; D017081:Cholecystectomy, Laparoscopic; D015897:Comorbidity; D005260:Female; D042882:Gallstones / Q000150:complications* / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery*; D006801:Humans; D015994:Incidence; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000150:complications* / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery*; D017410:Practice Guidelines as Topic; D012008:Recurrence; D012720:Severity of Illness Index; D016717:Sphincterotomy, Endoscopic; D013997:Time Factors; D014057:Tomography, X-Ray Computed