University of Illinois College of Medicine Peoria, IL, United States
Hasan Shoaib, MD1, Muhammad Asghar, MD1, Irfa Tariq, MBBS2, Saqib Walayat, MD3, Nadia Khalil, BS4, Aman Shaik, BS5, Sonu Dhillon, MD1 1University of Illinois College of Medicine, Peoria, IL; 2Sir Ganga Ram Hospital, Peoria, IL; 3University of Illinois, Peoria, IL; 4University of Texas Austin, Austin, TX; 5UC Irvine Graduate, Irvine, CA
Introduction: Gall stone pancreatitis is one of the most common causes of acute pancreatitis (30-50%). While most of the major societies recommend early cholecystectomy for mild gallstone pancreatitis, the timing of early cholecystectomy remains of much debate and the definition of early remains highly variable across the literature. The aim of our meta-analysis was to compare biliary complications, conversion to open cholecystectomy, intra-operative, and post-operative complications between patients who underwent early cholecystectomy, defined as cholecystectomy within 72 hours versus those who underwent late cholecystectomy.
Methods: Randomized controlled trials comparing outcomes of cholecystectomy performed within 72 hours of admission vs late cholecystectomy were included. Biliary complications were defined as recurrent pancreatitis, acute cholecystitis, acute cholangitis, biliary colic, jaundice, CBD duct injury and bile leakage. Articles were searched in Medline, Pubmed, and Cochrane database. Rev man 5.4 was used to analyze data.
Results: Initial search identified 163 reference articles, of which 45 were selected and reviewed. Nine studies (N=1046) that met the inclusion criteria were included in this analysis. Mean age of patients in early group was 40.5 years while that in the late group was 40.2 years. Odds of biliary complications were significantly lower if cholecystectomy was performed within 72 hours of admission [OR: 0.17, 95% CI= 0.10-0.29; p< 0.00001]. The chances of conversion to open cholecystectomy did not differ significantly whether cholecystectomy was performed within 72 hrs or later [OR: 1.27, 95% CI= 0.63-2.58; p=0.50]. Odds of intraoperative complications also did not differ significantly if cholecystectomy was performed within 72 hrs or later [OR: 0.64, 95% CI= 0.18-2.28; p=0.49]. Postoperative complications did not differ significantly whether cholecystectomy was performed within 72 hours or later [OR: 0.73, 95% CI= 0.4-1.32; p=0.30]
Discussion: Our results show that in patients with mild gall stone pancreatitis, performing cholecystectomy within 72 hours does not increase but rather decreases biliary complications. The rate of intra operative complications, post operative complications and chances of conversion to open cholecystectomy do not significantly differ whether cholecystectomy is performed within 72 hours or later. These results have important implications as earlier cholecystectomy could lead to earlier discharge and therefore reduce the financial burden.
Figure: Forrest plot for Biliary complications in patients undergoing cholecystectomy within 72 hr vs delayed cholecystectomy
Disclosures: Hasan Shoaib indicated no relevant financial relationships. Muhammad Asghar indicated no relevant financial relationships. Irfa Tariq indicated no relevant financial relationships. Saqib Walayat indicated no relevant financial relationships. Nadia Khalil indicated no relevant financial relationships. Aman Shaik indicated no relevant financial relationships. Sonu Dhillon indicated no relevant financial relationships.
Hasan Shoaib, MD1, Muhammad Asghar, MD1, Irfa Tariq, MBBS2, Saqib Walayat, MD3, Nadia Khalil, BS4, Aman Shaik, BS5, Sonu Dhillon, MD1. P0005 - Early vs Delayed Cholecystectomy for Mild Gallstone Pancreatitis? A Meta-Analysis of Randomized Controlled Trials, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.
