Optimal timing of laparoscopic cholecystectomy for mild acute gallstone pancreatitis
ZHOU Yan1 YAN Jun2
1.First Clinical School of Shanxi Medical University,Taiyuan 030001, China; 2. General Surgery Department, First Hospital of Shanxi Medical University,Taiyuan 030001, China
Abstract：Objective To investigate the best timing of laparoscopic cholecystectomy for mild acute gallstone pancreatitis.Methods Totally 150 cases of mild acute biliary pancreatitis(MABP) admitted to the First Hospital of Shanxi Medical University between January 1, 2016 to June 30, 2018 were enrolled.All these cases underwent laparoscopic cholecystectomy(LC). According to the time of start of surgery,the patients were divided into three groups: group A (emergency operation)(＜72 h, n=10),group B (early operation) (72 h-2 weeks, n=50) and group C (deferred operation)(＞2 weeks, n=90). The intraoperative blood loss volume,duration of surgery,length of hospital stay, medical expense,such biochemical indexes as levels of alanine aminotransferase(ALT),aspartate aminotransferase(AST)and total bilirubin (TBIL)before operation and 3d after operation,the incidence of postoperative complications(pseudocyst and pancreatic abscess), recovery and recurrence of pancreatitis were analyzed.Results Group C had the longest hospital stay[36(34,37)d] and the highest medical expense[76,000(74,000 and 77,000)yuan], while group A had the shortest hospital stay[15(14,16)d] and the minimum medical expense[36,000(34,000 and 37,300)yuan], The duration of surgery of the three groups was[(48.08±7.52)min,(61.16±6.35)min and(74.86±8.68)min respectively](P<0.05).Levels of ALT,AST,TBIL,amylase, lipase, blood glucose and hemameba decreased significantly 3 d after operation, but the level of blood calcium was higher than before(P<0.05). There was significant difference in levels of ALT and AST 3 d after operation between these groups (P<0.05). but there was no significant difference in the incidence of postoperative complications or the rate of recurrence between these groups.Conclusions Mild biliary AP patients should be operated on within 72 hours of onset.
Banks P A,Bollen T I,Dervenis C,et al.Classification of acute pancreatitis-2012:revision of the Atlanta classification and definitions by international consensus[J].Gut,2013,62:102-111.
Zhu H M,Zhang M,Li B Y,et al.Relevance between small intestinal bacterial overgrowth and complications of severe acute pancreatitis[J]. Chin Med,2017,12(6):884-887.
[8]
Gao S P,Li Z J,Zhang L,et al.Laparoscopic cholecystectomy operation timing of cholecvstolithiasis complicated with biliary pancreatitis[J].Guide Chin Med,2014,12(17):32-33.
Mador B D, Panton O N, Hameed S M. Early versus delayed cholecystectomy following endoscopic sphincterotomy for mild biliary pancreatitis [J]. Surg Endosc, 2014. 28(12):3337-3342.
[14]
Nebiker C A, Frey D M, Hamel C T, et al. Early versus delayed cholecystectomy cystectomy in patientswith biliary acutepancreatitis[J]. Surgery, 2009, 145(3): 260-264.
Alper B, Mehmet T, Ersin G, et al. Early versus delayedlaparoscopic cholecystectomy for acute cholecystitis: a prospective,randomized study[J]. Int Surg, 2014, 99(1): 56-61.
[20]
Bouwense S A, Besselink M G, Brunschot S, et al. Pancreatitis of biliary origin, optimaltiming of cholecystectom (PONCHO trial): study protocol for a randomized controlled trial[J]. Trials, 2012, 13: 225.
[21]
Beninato T, Kleiman D A, Soni A, et al. Expanding the indications for singleincision loaparoscopic cholecysteetomy to all patients with biliary disease: is it safe?[J]. Surg Laparosc Endosc Percutan Tech,2015,25(1):10-14.
2019, Vol. 30 
