Early laparoscopic cholecystectomy following acute biliary pancreatitis expedites recovery

BACKGROUND: In this retrospective study, we aimed to assess the reliability of early cholecystectomy, risk of recurrent biliary pancreatitis, and their effects on hospital length of stay and morbidity by comparing the results of early and late laparoscopic cholecystectomy in patients with acute biliary pancreatitis.
METHODS: A total of 131 patients, who were diagnosed with acute biliary pancreatitis at Okmeydaný Education and Research Hospital in January 2009–December 2012, were included in the study. Demographic specifications of patients, duration of their complaints, biochemistry and hemogram values at first arrival, Ranson criteria, number of attacks, screenings, operation type and period, number of days between the first attack and operation, hospital length of stay, and complications were recorded. Patients who underwent cholecystectomy within the first 2 weeks were considered early (group 1) and those who under the operation after 2 weeks were considered late (group 2).
RESULTS: There were 47 patients in group 1 and 84 patients in group 2. Open surgery was not performed on any patient, and there was no choledoch injury and mortality. The average hospital length of stay was 7.6±3.0 days in group 1 and 10.7±8.3 days in group 2, with a statistically significant difference between the groups (p=0.006). Two or more number of attacks occurred in 15 patients in group 2 (18%), with a statistically significant difference between the groups (p=0.000).
CONCLUSION: Laparoscopic cholecystectomy is safe as it does not increase operation time and morbidity in biliary pancreatitis with a Ranson score of ≤3 or cause difficulty in dissection. Late cholecystectomy causes recurrent attacks and increases the hospital length of stay and treatment costs. Using randomized controlled studies, the effectiveness and reliability of early cholecystectomy in mild and moderate biliary pancreatitis can be verified.

Akut biliyer pankreatiti izleyen erken laparoskopik kolesistektomi iyileþme sürecini kýsaltýr

AMAÇ: Bu geriye dönük çalýþmamýzda akut biliyer pankreatitli hastalarda erken ve geç laparoskopik kolesistektomi sonuçlarýmýzý karþýlaþtýrarak, erken kolesistektominin güvenilirliðini, tekrarlayan biliyer pankreatit riskini, yatýþ günü ve morbidite üzerindeki etkilerini araþtýrmayý amaçladýk.
GEREÇ VE YÖNTEM: Okmeydaný Eðitim ve Araþtýrma Hastanesinde Ocak 2009 – Aralýk 2012 arasýnda akut biliyer pankreatitli 131 hasta çalýþmaya alýndý. Hastalarýn demografik özellikleri, þikayetlerinin süresi, ilk geliþteki biyokimya ve hemogram deðerleri, Ranson skoru, atak sayýsý, görüntülemeler, ameliyat türü ve süresi, ilk ataktan ameliyata kadar geçen gün sayýsý, yatýþ günü ve komplikasyonlar kaydedildi. Ameliyatlarýný ilk iki haftada olanlar erken (Grup 1), iki haftadan sonrakiler geç (Grup 2) olarak deðerlendirildi.
BULGULAR: Grup 1’deki 47, Grup 2’deki 84 hastaya laparoskopik kolesistektomi yapýldý. Hiçbir olguda açýk ameliyata geçilmedi, koledok yaralanmasý olmadý ve mortalite geliþmedi. Yatýþ günü ortalamasý, Grup 1’de 7.6±3.0 gün, Grup 2’de 10.7±8.3 gün idi ve gruplar arasýnda istatistiksel anlamlý fark bulundu (p=0.006). Ýki ve üzerinde atak sayýsý Grup 2’deki hastalarýn 15’inde (%18) saptandý ve istatistiksel anlamlý fark bulundu (p=0.000).
TARTIÞMA: Ranson ≤3 biliyer pankreatitlerde erken laparoskopik kolesistektomi, operasyon süresi ve morbiditeyi artýrmadýðýndan ve diseksiyon güçlüðü yaratmadýðýndan güvenle uygulanabilir. Geç kolesistektomiler tekrarlayan ataklar, yatýþ günü ve tedavi maliyetlerinde artýþa neden olmaktadýr. Randomize kontrollü çalýþmalarla hafif ve orta biliyer pankreatitlerde erken kolesistektominin etkinliði ve güvenilirliði doðrulanmalýdýr.