الفهرس 
AnatomyOnly 14 pages are availabe for public view
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Abstract
Gallstone pancreatitis is the most common etiology of acute pancreatitis accounting for up to sixty percent of all cases. In patients with mild gallstone pancreatitis – characterized by the absence of organ failure, peripancreatic fluid collections or necrosis, and typical resolution within one week – cholecystectomy is the definitive treatment.
Cholecystectomy can be performed early, normally defined as during the index hospital admission, or can be delayed and performed in an elective setting. Without definitive treatment, the recurrence rate of gallstone pancreatitis is as high as 60%. ERCP and sphincterotomy can also prevent gallstones from causing recurrent pancreatitis, but will not prevent other complications of cholelithiasis, namely, cholecystitis.
Early cholecystectomy in the same index admission for mild gallstone pancreatitis has been reported in observational studies to be associated with reduced hospital length of stay (LOS) without increasing complications.
Since the time of intervention for management of mild gallstones pancreatitis by laparoscopic cholecystectomy represents major conflict and may be associated with pancreatitis recurrence, comparing the early and delayed laparoscopic cholecystectomy in patients with mild gallstone pancreatitis in order to establish the best timing for cholecystectomy to prevent pancreatitis recurrence and reduce intra- and post-operative cholecystectomy complications was highlighted as a main point of interest.
In this study, we aimed to determine the feasibility of early cholecystectomy during index admission as long as the symptoms and laboratory values are improving for patients with gallstone pancreatitis predicted to be mild on admission and to obtain unbiased estimates of the effect of early cholecystectomy on hospital LOS, complications, and patient-reported outcomes (PROs) in order to determine the need for further evaluation.
This prospective comparative study was conducted at tertiary care hospital at Ain Shams University hospitals and Nasser institute for medical research and treatment from May 2022 till December 2022 and performed on a total of 20 adult patients who aged 18 years old and over with mild pancreatitis and without cholangitis.
The current study revealed that there was no significant difference between the studied groups regarding baseline Demographic and comorbid data (gender, epigastric pain, nausea/vomiting, comorbidities and age) (p values = 0.47, 1.00, 1.00, 1.00, 0.32) respectively.
The current study results revealed that there was no significant difference between the studied groups regarding baseline clinical and laboratory data (CBD diameter, AST, ALT, total, direct bilirubin and TLC) (p values = 0.47, 1.00, 1.00, 1.00, 0.32) respectively while amylase and lipase are significantly high in early operation group compared to late operation group (p value=0.003, 0.009) respectively.
As regards operative time and complications, our study results revealed that patients treated with early or late procedure experienced approximately the same intra operative bleeding (30 vs 50%), conversion to open (10 vs 10%), biliary injury (0 vs 0%), and operation time (50 vs 50 minutes) with no statistically significant differences between them (p value= 1.00, 0.65, 0.912) respectively.
As regards hospital stay, our study results revealed that there were statistically significant differences between the studied groups as the patients intervened early had a lower estimated mean ± SE hospital stay days of 3.7 ± 0.26 compared to patients intervened late with an estimated mean ± SE hospital stay days of 8.6 ± 0.67.
We concluded that early cholecystectomy after gallstone pancreatitis is more advantageous than late cholecystectomy after gallstone pancreatitis because it is associated with less rate of recurrence of biliary pancreatitis, less complication of pancreatitis, less perioperative complication (adhesions, blood loss, biliary events, infection, postoperative pain) and shorter duration of postoperative hospital stay.
The feasibility and safety of early cholecystectomy in mild gallstone pancreatitis was affirmed. But we need another study with larger sample size and longer duration to get stronger significant results.
We recommend applying early laparoscopic cholecystectomy which is the safer and more effective approach in patients with mild gallstone pancreatitis.