Early versus interval cholecystectomy after mild acute gallstone pancreatitis: a 10 year experience in central Saudi Arabia

ABSTRACT

To study the safety of early cholecystectomy [EC] during the index admission following acute mild gallstone pancreatitis, focusing on conversion rate, biliary injuries, length of hospital stay and recurrent gallstone related events. Medical records of all patients who were admitted with a diagnosis of acute mild gallstone pancreatitis at King Saud Medical City, Riyadh, Kingdom of Saudi Arabia between January 2003 and December 2012 were studied retrospectively and reviewed in relation to age, gender, presenting symptoms, laboratory findings, imaging studies, timing of cholecystectomy, biliary injury, intraoperative bleeding, conversion to open surgery, duration of surgery, operating surgeons, hospital stay, recurrent gallstone related events and mortality. Out of 386 patients admitted with acute mild gallstone pancreatitis, 267 patients underwent EC which was successfully performed in 256 cases. Conversion to open cholecystectomy was needed in 11 cases. The rest of the patients [n = 119] were discharged after successful conservative treatment for interval cholecystectomy [IC] after 6-12 weeks. IC was performed on 83 patients, two were converted to open cholecystectomy. Hospital stay was significantly shorter in the EC [P < 0.0001] while the recurrent gallstone related events were significantly higher in IC [P < 0.0001]. There was no significant difference in conversion rate [P = 0.567], and biliary complications [P = 0.663]. EC following acute mild gallstone pancreatitis was found to be a safe procedure when performed during the index admission. There was no significant increase in conversion rate or bile duct injuries. In fact, EC resulted in significant reduction in the hospital stay as well as in the recurrent gallstone related events