Timing of Cholecystectomy After Mild Biliary Pancreatitis
Timing of Cholecystectomy After Mild Biliary Pancreatitis
van Baal MC, Besselink MG, Bakker OJ, et al; Dutch Pancreatitis Study Group
Ann Surg. 2012;255:860-866
When is the best time to perform definitive cholecystectomy in patients who have had a mild attack of biliary pancreatitis? The authors reviewed 2413 studies reported in the literature between 1992 and 2010 and found 8 cohort studies and 1 randomized trial designed to answer this question.
Overall, the frequency of index cholecystectomy performed during the initial attack was about the same as that for interval cholecystectomy: 483 vs 515 patients, respectively. The complication rates also seemed to be similar (6% vs 4%). The studies differed in the definition used to diagnose mild acute biliary pancreatitis.
Despite reviewing an enormous number of reports, the authors found only 8 follow-up studies and a single randomized trial that were suitable for review. Cholecystectomy during the initial hospitalization seems to be safe and avoids the risk for another attack of pancreatitis. Because of methodologic differences in the included reports, the authors emphasized that we still need evidence from additional randomized trials to determine whether early surgery is preferable to delayed surgery.
Abstract
Timing of Cholecystectomy After Mild Biliary Pancreatitis: A Systematic Review
van Baal MC, Besselink MG, Bakker OJ, et al; Dutch Pancreatitis Study Group
Ann Surg. 2012;255:860-866
Summary
When is the best time to perform definitive cholecystectomy in patients who have had a mild attack of biliary pancreatitis? The authors reviewed 2413 studies reported in the literature between 1992 and 2010 and found 8 cohort studies and 1 randomized trial designed to answer this question.
Overall, the frequency of index cholecystectomy performed during the initial attack was about the same as that for interval cholecystectomy: 483 vs 515 patients, respectively. The complication rates also seemed to be similar (6% vs 4%). The studies differed in the definition used to diagnose mild acute biliary pancreatitis.
Viewpoint
Despite reviewing an enormous number of reports, the authors found only 8 follow-up studies and a single randomized trial that were suitable for review. Cholecystectomy during the initial hospitalization seems to be safe and avoids the risk for another attack of pancreatitis. Because of methodologic differences in the included reports, the authors emphasized that we still need evidence from additional randomized trials to determine whether early surgery is preferable to delayed surgery.
Abstract
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