Comparative Study between Early versus Delayed Laparoscopic Cholecystectomy in Mild Acute Gallstone Pancreatitis
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- Category: Vol. 89, December 2021
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Comparative Study between Early versus Delayed Laparoscopic Cholecystectomy in Mild Acute Gallstone Pancreatitis, HATEM S. SABER, ABD ELGHANY M. ALSHAMY, MOHAMMED I. ALI and KAMAL M. ELSAID
Abstract
Background: Gallstone pancreatitis accounts for around a quarter of all pancreatitis cases. As a result, cholecystectomy is regarded a definite curative treatment for gallstone pancre-atitis since it eliminates the source of stones, preventing further bouts of pancreatitis. Although there is agreement that cholecystectomy is the final treatment, there is still debate over the appropriate time to do the surgery in order to receive the greatest results and avoid complications. Aim of Study: The goal of the study is to evaluate 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 com-plications. Patients and Methods: The data of 40 patients with mild acute gallstone pancreatitis who came for the first time to the Department of General Surgery at Ain Shams University Hospitals in Cairo, Egypt, were gathered between December 2020 and July 2021 for this randomized prospective study. They were split into 2 groups: Group A had an early laparo-scopic cholecystectomy within one week of admission, and group B had a delayed cholecystectomy six weeks later. Results: Four men (20%) and sixteen females (80%) were in the early group, while two males (20%) and sixteen females were in the delayed group. 80%, In terms of age (p=0.109), the index group's mean age SD was 39.70±8.82 years, with a range of 27 to 50 years, whereas the delayed group's mean age SD was 46.50±9.05 years, with a range of 32 to 59 years. All of the cases were given a thorough history and a thorough clinical examination. All patients (100%) had abdominal discomfort as their presenting symptom, and all patients in groups A had laparoscopic cholecystectomy (LC) without diversion to open cholecystectomy. In group B, 2 cases were converted to open cholecystectomy, all patient have good perstalisis and started oral fluid at same postoperative day, 0% risk of recurrence of biliary pancreatitis in group A and 50% in group B. There was no significant difference in bleeding between both group. Patients who had late cholecys-tectomy had a higher rate of postoperative wound infection than those who had an early cholecystectomy, but there was insignificant difference. There was no significant difference in biliary complication (biliary damage) across both groups (biliary leak or missed stone). Post-operative pain is higher in late cholecystectomy patients than in early cholecystectomy patients, although the difference is not significant. Patients who had late cholecystectomy stayed in the hospital longer than those who had an early cholecystectomy. Patients were monitored for one month after surgery, with no mortality or complications. Conclusion: The current study discovered that early cholecystectomy after mild gallstone pancreatitis is better than doing it late because it is linked to a lower rate of biliary pancreatitis recurrence, fewer pancreatitis complications, fewer perioperative complications (adhesions, blood loss, biliary events, infection, postoperative pain), and a shorter recovery time.