Document Detail


Timing of cholecystectomy for biliary pancreatitis: do the data support current guidelines?
MedLine Citation:
PMID:  18636298     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Current guidelines suggest that cholecystectomy be performed within 2 weeks after discharge following an episode of biliary pancreatitis. We hypothesized that a high incidence of gallstone-related events is present within 2 weeks after discharge prior to cholecystectomy. METHODS: Two hundred eighty-one patients who underwent cholecystectomy for biliary pancreatitis (January 1999-December 2005) were categorized into one of two groups: group A patients underwent cholecystectomy during index admission (n = 162), and group B patients underwent cholecystectomy following discharge from index admission (n = 119). RESULTS: Groups were comparable in demographics, comorbidities, and disease severity. Thirty-nine (32.8%) group B patients experienced pre-cholecystectomy gallstone-related events (including 16 cases of recurrent pancreatitis) after discharge. Recurrences (31.3%) occurred within 2 weeks after discharge. Endoscopic sphincterotomy protected against preoperative recurrent pancreatitis but was associated with a higher incidence of other gallstone-related events. Median total length of hospital stay was greater for group B than for group A [7 (range, 2-37) days vs. 5 (1-45) days, respectively, p = 0.00]. CONCLUSION: Current guidelines suggesting the appropriateness of waiting up to 2 weeks for cholecystectomy for biliary pancreatitis may place patients at unacceptably high risk for recurrence. Endoscopic sphincterotomy does not eliminate the risk of gallstone-related events.
Authors:
Kaori Ito; Hiromichi Ito; Edward E Whang
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Publication Detail:
Type:  Journal Article     Date:  2008-07-18
Journal Detail:
Title:  Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract     Volume:  12     ISSN:  1873-4626     ISO Abbreviation:  J. Gastrointest. Surg.     Publication Date:  2008 Dec 
Date Detail:
Created Date:  2008-11-26     Completed Date:  2009-04-20     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9706084     Medline TA:  J Gastrointest Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2164-70     Citation Subset:  IM    
Affiliation:
Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Chi-Square Distribution
Cholangiopancreatography, Endoscopic Retrograde
Cholecystectomy*
Cholecystectomy, Laparoscopic
Comorbidity
Female
Gallstones / complications*,  epidemiology,  radiography,  surgery*
Humans
Incidence
Length of Stay / statistics & numerical data
Male
Middle Aged
Pancreatitis / complications*,  epidemiology,  radiography,  surgery*
Practice Guidelines as Topic*
Recurrence
Severity of Illness Index
Sphincterotomy, Endoscopic
Time Factors
Tomography, X-Ray Computed

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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