Early and delayed laparoscopic cholecystectomy in patients with biliary acute pancreatitis

Introduction and ObjectiveAcute pancreatitis is a result of pancreas auto-digestion with the activation of pancreatic digestive enzymes. The clinical picture shows a heterogeneous distribution extending from moderate edematous pancreatitis to severe necrotic pancreatitis with 20% mortality. In this study, we aimed to compare the results of early and late laparoscopic cholecystectomy (LC) and to investigate their effects on mortality and morbidity in patients with acute biliary pancreatitis (ABP).Patients and MethodsOne hundred eight patients, who underwent LC with the diagnosis of moderate acute pancreatitis in our clinic between January 2005 and September 2010, were enrolled in this study. The patients were divided into two groups as early LC group (group-A) and late LC group (group B). The demographic characteristics, type of surgery, operating time, conversion rate of open surgery, complications, mortality and hospital stay were recorded. The complications were defined as ınjury of the bile ducts and biliary fistula in the patients. The patients who underwent LC within the first fifteen days after the onset of attacks of pancreatitis were evaluated in group A and the patients who underwent LC later than the fifteen days were evaluated in group B.ResultsThe number of the patients was 46 in group A and 62 in group B. The mean age was 52.9 (23-84) years in group A and 51.9 (19-82) years in group B. The distribution of women and men were 35/11 (76.1% / 23.9%) in group A, and 44/18 (71.0% / 29.0%) in group B, respectively. LC was performed successfully in 43 (93.5%) patients of group A and in 58 patients of group B. We had to perform open surgery in 3 (6.5%) patients in group A and 4 (6.4%) patients in group B. There was no difference between the two groups in terms of the rates of conversion to open surgery. There were no complications in both groups. One patient in group A died due to necrotizing pancreatitis at the postoperative period. The average operation times were 70.5 minutes in group A and 68.6 minutes in group B. The average postoperative hospital stays were 2.8 days in group A and 3.0 days in group B. There were no differences in terms of operation time and postoperative hospital stay between the groups.ConclusionEarly LC did not increase the rates of conversion to open surgery and biliary tract complications. On the other hand, the rate of recurrent pancreatitis attacks was higher in group B correlated with the duration of elapsed time for LC. Therefore, we recommend early LC for protect the patients from the morbidity and mortality of the recurrent attacks in the patients with mild to moderate pancreatitis.Key Words: Acute pancreatitis, laparoscopic cholecystectomy, timing of operation