BACKGROUND: Owing to the high incidence of gall stones in our locality, acute pancreatitis with its complications remains a continuous risk. For that reason cholecystectomy is of prime importance to avoid this problem but the proper timing for cholecystectomy still remaining a subject of ongoing debate.
Aim: The aim of this prospective randomized study is to compare the outcome of early (index admission, within 48-72 hours) versus delayed (after resolution of abdominal pain and normalization of laboratory values) lap. cholecystectomy in patients presenting with mild to moderate acute biliary pancreatitis admitted at Sohag University Hospital, Egypt.
Patients and methods: From October 2009 to June 2012, a total number of 42 patients admitted at Surgery Department, Sohag University Hospital, Egypt, with mild to moderate acute biliary pancreatitis (Ranson’s score ≤3) underwent laparoscopic cholecystectomy(LC). Patients with severe and necrotizing pancreatitis based on contrast enhanced CT scan were excluded from the study. Patients were randomly classified into two groups: Group (A) 20 cases (study group) underwent LCwithin 48-72 hours of admission and Group (B) 22 cases (control group) underwent LC after resolution of abdominal pain and laboratory values (≥14 days). Patients with proved and persistent CBD stone underwent ERCP and endoscopic sphinctrotomy followed later by LC.The end point was morbidity and mortality, hospital stay and conversion rate.
Results: Between October 2009 and June 2012, a total number of 576 cholecystectomies were done in our institution, out of which 52 cases (9.02 %) presented with picture of acute biliary pancreatitis. After confirmation of diagnosis and assessment of severity, 10 cases were excluded as they had severe and necrotizing pancreatitis. Forty two cases who met the criteria of mild to moderate acute pancreatitis were enrolled in the study. Group (A) included 20 cases (8 males &12 females) and Group (B) included 22 cases (6 males &16 females). Both groups were matched as regard age, sex, clinical presentation and severity of pancreatitis. No intra-operative complications occurred in both groups except in three cases of bleeding one in group A and two in group B and the bleeder was controlled without need for conversion . No CBD injuries encountered in both groups either intra or post operative course. Operative time was slightly longer in group A (mean op. time was 62±11 min vs. 55±13min) in Group B. Conversion was required in one and two cases in both groups respectively. Common bile duct stones were found in 2&4 cases in both groups respectively, all required ERCP and endoscopic sphinctrotomy prior to cholecystectomy. Two cases of bile leakage occurred in Group A and one case in Group B, all of them didn’t need intervention. Wound sepsis occurred in two cases in Group B and one in group A which was treated conservatively. Hospital stay was longer in Group B (mean15±1.3 days) which was statistically significant (p value<0.05) compared by Group A (mean3±2.1days). Three patients in group B required readmission because of acute cholecystitis (one case), and recurrent acute pancreatitis (two cases). No mortalities in any studied patients.
Conclusion: Laparoscopic cholecystectomy within index admission found to be safe with no increase in morbidity or mortality. It has the advantage of solving the problem within same admission, abolishing risk of recurrence and complications of delayed treatment