title: Timing of cholecystectomy in acute biliary pancreatitis: is it still reasonable to wait?
abstract: BACKGROUND
  Acute gallstone-related pancreatitis is a potentially life-threatening condition, and its adequate therapy is represented by cholecystectomy. The aim of this study was to analyze the best surgical strategy, and the optimal timing.
  
  
  METHODS
  All cases of acute pancreatitis of biliary origin occurred between January 2007 and December 2013 in Gradenigo Hospital (Turin, Italy) undergone to a surgical procedure, were reviewed. Patients were divided in two groups, based on the timing of cholecystectomy, and compared.
  
  
  RESULTS
  Out of 2233 cholecystectomies performed in the mentioned time interval, we have identified 79 patients that fulfill the selection criteria. 24 patients were treated with an index-stay procedure, while 55 with a delayed approach. Length of stay was significantly lower in patients that underwent to an early laparoscopic cholecystectomy (9 vs. 13 days, P=0.003), while no differences were found in terms of length of intervention, intraoperative complications, postoperative stay and mortality. Patients treated with delayed surgery had a 28.6% recurrence rate of acute pancreatitis, with an odds ratio of 10.28 (P=0.02).
  
  
  CONCLUSIONS
  Early laparoscopic cholecystectomy should be performed in suitable patients in the index admission, reducing overall risks, avoiding or at least minimizing recurrencies, and rationalizing the scarce economic resources.
authors.affiliation: Department of General Surgery Gradenigo Hospital, Turin, Italy - d.borreca@policlinicoumberto1.it.
authors.forename: Dario
authors.initials: D
authors.lastname: Borreca
authors.forename: Alberto
authors.initials: A
authors.lastname: Bona
authors.forename: Maria P
authors.initials: MP
authors.lastname: Bellomo
authors.forename: Andrea
authors.initials: A
authors.lastname: Borasi
authors.forename: Paolo
authors.initials: P
authors.lastname: DE Paolis
mesh_terms: D000328:Adult; D000368:Aged; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002763:Cholecystectomy / Q000379:methods; D017081:Cholecystectomy, Laparoscopic / Q000379:methods; D061887:Conversion to Open Surgery; D005260:Female; D042882:Gallstones / Q000150:complications* / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D017408:Guidelines as Topic; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D018579:Patient Selection; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D057832:Watchful Waiting