Early surgical treatment contributes to better outcomes in gallstone pancreatitis cases

Dec 20 2007

Although delaying surgical treatment remains the standard of care for patients with severe gallstone pancreatitis, a new study published in the December issue of the Journal of the American College of Surgeons shows that, contrary to widespread belief, early cholecystectomy -- or surgical removal of the gallbladder -- significantly reduces hospital stays in patients with mild to moderate gallstone pancreatitis with no increase in complications or mortality.

Gallstones -- the small, pebble-like deposits that develop in the gallbladder -- are the leading cause of acute pancreatitis (inflammation of the pancreas) in the United States. Although delaying an operation remains the standard of care for severe gallstone pancreatitis, the timing of cholecystectomy for mild to moderate gallstone pancreatitis is controversial, with many surgeons believing that the surgical procedure should be delayed until laboratory abnormalities and symptoms have resolved.

“This study dispels the notion that the later the cholecystectomy, the better the outcome in patients with mild to moderate gallstone pancreatitis. We found excellent outcomes in patients undergoing the procedure within two days of hospitalization,” lead investigator of the study David K. Rosing, MD, Harbor-UCLA Medical Center, said. “Perhaps most importantly, we found that early cholecystectomy reduces the time these patients are in the hospital by three or four days, which benefits both the individual patient and the hospital.”

Researchers conducted a cohort study consisting of a retrospective (n=177) and prospective group (n=43) to investigate the optimal timing of laparoscopic cholecystectomy for patients with mild to moderate gallstone pancreatitis. For the prospective group, cholecystectomy was performed less than 48 hours from admission, before resolution of laboratory or physical examination abnormalities were resolved. The primary endpoint was total length of hospital stay. Secondary endpoints included major complications (organ failure and death).

By using a protocol of early cholecystectomy in the prospective group, the total length of stay was significantly reduced from seven to four days (p<0.001). Median time from admission to cholecystectomy was five days in the retrospective group versus two days in the prospective group. Complication rates were similar, and there were no deaths in either group.