Patients with mild gallstone pancreatitis can safely have a laparoscopic cholecystectomy within 48 hours of admission, and it appears to shorten their length of stay compared to those who wait longer, a new study found.
Researchers did a retrospective review of 303 patients from two
teaching hospitals in southern California. They sought patients
who underwent laparoscopic cholecystectomy (LC) for mild
gallstone pancreatitis between 2006 and 2011. The mean patient age
was 37 years, and 78.2% of patients were female. Of the 303
patients, 38.6% (n=117) underwent an early LC and 61.4% (n=186) underwent a delayed LC. There were no differences between groups in terms of sex, lab results or vital signs at admission,
or Ranson score at admission, though the early LC group was slightly older (40 vs. 35 years; P=0.006). The most common reason for delayed LC was to wait for bilirubin or pancreatic enzyme levels to normalize.
Patients who had early LC had a significantly shorter mean length of stay (LOS) than those who had late LC (3.4 days vs. 6.3
days; P<0.001). The mortality rate was 0% in both
groups, and there were no differences between groups in complication
readmissions within 30 days, or conversion from LC to open
cholecystectomy. There was no difference between groups in use
of postoperative endoscopic retrograde cholangiopancreatography
(ERCP), though preoperative ERCP use was higher in the delayed
LC group (17% vs. 6%; P=0.004). Results were published online July 16 by Archives of Surgery.
The results indicate early LC can safely be performed for mild
gallstone pancreatitis without the need for lab values to normalize
or clinical symptoms to resolve completely, the authors noted. A
potential danger exists for patients identified as having
mild pancreatitis whose condition worsens, as research has
shown early LC to be harmful in those with serious pancreatitis,
they said. However, none of the 303 study patients with mild
pancreatitis progressed to severe pancreatitis. "We believe the
safety of an early LC lies in the identification and exclusion
of patients who may be at risk of progressing to a more severe
pancreatitis, such as those with tachycardia, elevated serum
urea nitrogen level, or evidence of cholangitis at hospital admission,"