Sunday, August 5, 2012

No harm in early laparoscopic cholecystectomy for mild gallstone pancreatitis

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 rates, 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," they wrote.

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