title: The impact of timing of cholecystectomy following gallstone pancreatitis.
abstract: BACKGROUND
  Current guidelines for the management of acute gallstone pancreatitis recommend cholecystectomy as definitive treatment during primary admission or within 2 weeks of discharge, with the aim of preventing recurrent pancreatitis. However, cholecystectomy during the inflammatory phase may increase surgical complication rates. This study aimed to determine whether adherence to the guidelines prevents recurrent pancreatitis while minimising surgical complications.
  
  
  METHODS
  Multi-centre review of seven UK hospitals, indentifying patients presenting with their first episode of gallstone pancreatitis between 2006 and 2008.
  
  
  RESULTS
  A total of 523 patients with gallstone pancreatitis were identified, of which 363 (69%) underwent cholecystectomy (72 during the primary admission or within 2 weeks of discharge; 291 following this). Overall, 7% of patients had a complication related to cholecystectomy of which a greater proportion occurred when cholecystectomy was performed within guideline parameters (13% vs 6%; p = 0.07). 11% of patients were readmitted with recurrent pancreatitis prior to surgery, with those undergoing cholecystectomy outside guideline parameters being most at risk (p = 0.006).
  
  
  CONCLUSIONS
  This study suggests cholecystectomy within guideline parameters significantly reduces recurrence of pancreatitis but may increase the risk of surgical complications. A prospective randomised study to assess the associated morbidity is required to inform future guidelines.
authors.affiliation: West Midlands Research Collaborative, c/o Martha Holmes, Academic Department of Surgery, Room 29, 4th Floor, Queen Elizabeth Hospital, Edgbaston, Birmingham B15 2TH, United Kingdom. Electronic address: mariannejohnstone@hotmail.com.
authors.forename: Marianne
authors.initials: M
authors.lastname: Johnstone
authors.affiliation: West Midlands Research Collaborative, c/o Martha Holmes, Academic Department of Surgery, Room 29, 4th Floor, Queen Elizabeth Hospital, Edgbaston, Birmingham B15 2TH, United Kingdom.
authors.forename: Paul
authors.initials: P
authors.lastname: Marriott
authors.affiliation: West Midlands Research Collaborative, c/o Martha Holmes, Academic Department of Surgery, Room 29, 4th Floor, Queen Elizabeth Hospital, Edgbaston, Birmingham B15 2TH, United Kingdom.
authors.forename: T James
authors.initials: TJ
authors.lastname: Royle
authors.affiliation: West Midlands Research Collaborative, c/o Martha Holmes, Academic Department of Surgery, Room 29, 4th Floor, Queen Elizabeth Hospital, Edgbaston, Birmingham B15 2TH, United Kingdom.
authors.forename: Caroline E
authors.initials: CE
authors.lastname: Richardson
authors.affiliation: West Midlands Research Collaborative, c/o Martha Holmes, Academic Department of Surgery, Room 29, 4th Floor, Queen Elizabeth Hospital, Edgbaston, Birmingham B15 2TH, United Kingdom.
authors.forename: Andrew
authors.initials: A
authors.lastname: Torrance
authors.affiliation: West Midlands Research Collaborative, c/o Martha Holmes, Academic Department of Surgery, Room 29, 4th Floor, Queen Elizabeth Hospital, Edgbaston, Birmingham B15 2TH, United Kingdom.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Hepburn
authors.affiliation: West Midlands Research Collaborative, c/o Martha Holmes, Academic Department of Surgery, Room 29, 4th Floor, Queen Elizabeth Hospital, Edgbaston, Birmingham B15 2TH, United Kingdom.
authors.forename: Aneel
authors.initials: A
authors.lastname: Bhangu
authors.affiliation: West Midlands Research Collaborative, c/o Martha Holmes, Academic Department of Surgery, Room 29, 4th Floor, Queen Elizabeth Hospital, Edgbaston, Birmingham B15 2TH, United Kingdom.
authors.forename: Abhilasha
authors.initials: A
authors.lastname: Patel
authors.affiliation: West Midlands Research Collaborative, c/o Martha Holmes, Academic Department of Surgery, Room 29, 4th Floor, Queen Elizabeth Hospital, Edgbaston, Birmingham B15 2TH, United Kingdom.
authors.forename: David C
authors.initials: DC
authors.lastname: Bartlett
authors.affiliation: West Midlands Research Collaborative, c/o Martha Holmes, Academic Department of Surgery, Room 29, 4th Floor, Queen Elizabeth Hospital, Edgbaston, Birmingham B15 2TH, United Kingdom.
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Pinkney
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002763:Cholecystectomy / Q000592:standards*; D005260:Female; D005500:Follow-Up Studies; D042882:Gallstones / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010195:Pancreatitis / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D010865:Pilot Projects; D012008:Recurrence; D012189:Retrospective Studies
keywords: BSG guidelines; Cholecystectomy; ERCP; Gallstone pancreatitis