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Cholecystectomy 7 days vs 4 weeks after mild biliary pancreatitis; looking a decrease the incidence of persistent

Helena Gómez Facundo1, Ruth Ribas Montoliu, Daniel Rolando Coronado Llanos

  • 1General and Digestive Surgery Department, Moisès Broggi Hospital, CSI, Barcelona, Spain General and Digestive Surgery Department, Sant Joan de Déu Hospital, Martorell, Barcelona, Spain General and Digestive Surgery Department, Joan XXIII Hospital, Tarragona, Spain General and Digestive Surgery Department, Consorci Sanitari Garraf, Sant Pere de Ribes, Barcelona, Spain General and Digestive Surgery Department, Consorci Sanitari Vic, Vic, Barcelona, Spain General and Digestive Surgery Department, Dos de Maig Hospital, Barcelona, Spain Epidemiology Department, Moisès Broggi Hospital, CSI, Barcelona, Spain.

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PubMed
Summary

Early surgery for mild acute biliary pancreatitis significantly reduces readmissions without increasing complications or residual stones. This approach avoids unnecessary procedures like ERCP, improving patient outcomes.

Keywords:
Acute biliary pancreatitisCholecystectomyCholedocholithiasisERCP

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Area of Science:

  • Gastroenterology
  • Surgical Innovation
  • Biliary Disease Management

Background:

  • Mild acute biliary pancreatitis (MABP) necessitates gallstone treatment to prevent recurrence.
  • Early surgery is recommended to prevent hospital readmissions.
  • Timing of cholecystectomy is crucial to balance recurrence prevention and potential complications like missed choledocholithiasis.

Purpose of the Study:

  • To compare early (1 week) versus delayed (4 weeks) cholecystectomy after MABP.
  • To evaluate readmission rates for recurrent biliary events.
  • To assess the incidence of residual choledocholithiasis and the need for ERCP.

Main Methods:

  • A multicentre randomized clinical trial involving 198 patients with MABP.
  • Patients were randomized to early surgery (n=98) or delayed surgery (n=100).
  • Preoperative or intraoperative imaging was used to rule out persistent choledocholithiasis.

Main Results:

  • Early surgery halved readmission rates for biliary events before cholecystectomy (7.2% vs 15.8%, p=0.058).
  • No significant differences were observed in surgery type, postoperative stay, complications, or residual choledocholithiasis rates (9.0% vs 7.7%).
  • Imaging effectively minimized the need for ERCP (3% of patients).

Conclusions:

  • Performing cholecystectomy seven days after MABP resolution is safe and effective.
  • Early surgery leads to a low incidence of recurrent biliary events and complications.
  • This approach does not increase residual choledocholithiasis or the need for ERCP.