title: Early cholecystectomy for non-severe acute gallstone pancreatitis: easier said than done.
abstract: BACKGROUND
  Laparoscopic cholecystectomy (LC) carried out within 3 days after an attack of non-severe acute gallstone pancreatitis (NSAGP) is recommended to reduce hospital stay and overall costs. Aim of the study was to evaluate factors that may delay a timely surgical management of NSAGP and the consequences of this deviation.
  
  
  METHODS
  We reviewed the charts of patients admitted for NSAGP and managed by LC during the last 14 years. A total number of 316 patients entered the study, 98 of whom underwent early LC. A comparison of pre-operative and outcome data from the group of patients undergone early LC and those who received a delayed LC (>3 days since the admission) was made.
  
  
  RESULTS
  Only 31% of patients presenting with NSAGP were managed by early LC. Respect to these, patients who received a delayed LC were significantly older and had a greater occurrence of clinical signs suggesting common bile duct stones (CBDS). Stabilization of co-morbidities and need to investigate preoperatively the common duct were the main factors associated to the surgical delay. By comparing patients undergone early LC and those who received delayed LC, differences regarding conversion to open surgery (2% vs. 1.3%), need to explore the common bile duct (18.3% vs. 25.6%), CBDS clearance rates (94.4% vs. 94.6%), morbidity (8.1% vs. 8.7%), and postoperative hospital stay (3.9 vs. 3.2 days) were however statistically not significant.
  
  
  CONCLUSIONS
  Several reasons could delay the 3-day recommendation for surgery in NSAGP. These include the need to achieve before surgery the control of age-related co morbidities, and the workup to investigate for common duct stones. A fast track program aiming to early surgery would be advisable for patients presenting with NSAGP. Compared to delayed LC, early LC appears to shorten overall hospitalization but it does not seem to have any clinical impact on the course.
authors.affiliation: Emergency Surgery Unit, Cisanello Hospital, Pisa, Italy - simone5c@virgilio.it.
authors.forename: Simone
authors.initials: S
authors.lastname: Guadagni
authors.affiliation: Emergency Surgery Unit, Cisanello Hospital, Pisa, Italy.
authors.forename: Ismail
authors.initials: I
authors.lastname: Cengeli
authors.affiliation: School of General Surgery, Pisa, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Palmeri
authors.affiliation: Institute of Clinical Physiology, National Council of Research, Pisa, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Bastiani
authors.affiliation: Emergency Surgery Unit, Cisanello Hospital, Pisa, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Bertolucci
authors.affiliation: Emergency Surgery Unit, Cisanello Hospital, Pisa, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Modesti
authors.affiliation: Emergency Surgery Unit, Cisanello Hospital, Pisa, Italy.
authors.forename: Christian
authors.initials: C
authors.lastname: Galatioto
authors.affiliation: Emergency Surgery Unit, Cisanello Hospital, Pisa, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Chiarugi
mesh_terms: D000208:Acute Disease; D000367:Age Factors; D000368:Aged; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D042883:Choledocholithiasis / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery; D002769:Cholelithiasis / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D061887:Conversion to Open Surgery / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000000981:diagnostic imaging / Q000209:etiology; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D061665:Time-to-Treatment