Objectives: To determine the risk of recurrent biliary events in the period after mild biliary pancreatitis but before interval cholecystectomy and to determine the safety of cholecystectomy during the index admission.
Background: Although current guidelines recommend performing cholecystectomy early after mild biliary pancreatitis, consensus on the definition of early (ie, during index admission or within the first weeks after hospital discharge) is lacking.
Methods: We performed a systematic search in PubMed, Embase, and Cochrane for studies published from January 1992 to July 2010. Included were cohort studies of patients with mild biliary pancreatitis reporting on the timing of cholecystectomy, number of readmissions for recurrent biliary events before cholecystectomy, operative complications (eg, bile duct injury, bleeding), and mortality. Study quality and risks of bias were assessed.
Results: After screening 2413 studies, 8 cohort studies and 1 randomized trial describing 998 patients were included. Cholecystectomy was performed during index admission in 483 patients (48%) without any reported readmissions. Interval cholecystectomy was performed in 515 patients (52%) after 40 days (median; interquartile range: 19–58 days). Before interval cholecystectomy, 95 patients (18%) were readmitted for recurrent biliary events (0% vs 18%, P < 0.0001). These included recurrent biliary pancreatitis (n = 43, 8%), acute cholecystitis (n = 17), and biliary colics (n = 35). Patients who had an endoscopic retrograde cholangiopancreatography had fewer recurrent biliary events (10% vs 24%, P = 0.001), especially less recurrent biliary pancreatitis (1% vs 9%). There were no differences in operative complications, conversion rate (7%), and mortality (0%) between index and interval cholecystectomy. Because baseline characteristics were only reported in 26% of patients, study populations could not be compared.
Conclusions: Interval cholecystectomy after mild biliary pancreatitis is associated with a high risk of readmission for recurrent biliary events, especially recurrent biliary pancreatitis. Cholecystectomy during index admission for mild biliary pancreatitis appears safe, but selection bias could not be excluded.
Consensus on the optimal timing of cholecystectomy after mild biliary pancreatitis is lacking. This systematic review of 998 patients shows that performing cholecystectomy 40 days after discharge is associated with 18% risk of readmissions for biliary events, especially recurrent biliary pancreatitis. Cholecystectomy during index admission will prevent these recurrences but selection bias could not be excluded.
*Department of Operating Room/Evidence Based Surgery, Radboud University Nijmegen Medical Centre, Nijmegen
†Department of Surgery, University Medical Center, Utrecht
‡Department of Surgery, Leiden University Medical Center, Leiden
§Department of Surgery, University Medical Center Groningen, Groningen
‖Department of Surgery, St Antonius Hospital, Nieuwegein, the Netherlands.
Reprints: Marc G. H. Besselink, MD, PhD, Dutch Pancreatitis Study Group, Department of Surgery, University Medical Center Utrecht, HP G04.228, PO Box 85500, 3508 GA Utrecht, the Netherlands. E-mail: firstname.lastname@example.org.
Disclosure: The authors declare no conflicts of interest.
Presented at the Pancreas Club 2010 (May 1, 2010, New Orleans, Louisiana) and the European Pancreatic Club 2010 (June 17, 2010, Stockholm, Sweden).