Role of Early Elective Cholecystectomy in Acute Mild-To-Moderate Biliary Pancreatitis

Authors

  • Muhammad Umar Siddique Department of General Surgery, Pak-Emirates Military Hospital, Rawalpindi/National University of Medical Sciences (NUMS) Pakistan
  • Nasir Mehmud Wattoo Department of General Surgery, Pak-Emirates Military Hospital, Rawalpindi/National University of Medical Sciences (NUMS) Pakistan
  • Hira Department of Radiology, Pak-Emirates Military Hospital, Rawalpindi/National University of Medical Sciences (NUMS) Pakistan
  • Tayyaba Mushtaq Khan Department of General Surgery, Pak-Emirates Military Hospital, Rawalpindi/National University of Medical Sciences (NUMS) Pakistan
  • Muhammad Naeem Department of General Surgery, Pak-Emirates Military Hospital, Rawalpindi/National University of Medical Sciences (NUMS) Pakistan
  • Adil Maqbool Department of General Surgery, Pak-Emirates Military Hospital, Rawalpindi/National University of Medical Sciences (NUMS) Pakistan

DOI:

https://doi.org/10.51253/pafmj.v76iSUPPL-7.11955

Keywords:

Delayed Cholecystectomy, Early Cholecystectomy, Laparoscopic, Pancreatitis

Abstract

Objective: To compare the outcomes of early versus delayed laparoscopic cholecystectomy (LC) in patients with mild/moderate acute biliary pancreatitis (ABP).

Study Design: Prospective comparative study.

Place and Duration of Study: General Surgery Department of Pak-Emirates Military Hospital, Rawalpindi, Pakistan, from Jun 23 to Feb 24.

Methodology: The target population included patients who were diagnosed with mild/moderate ABP. 138 participants were distributed equally into two groups:(1) Early LC Group (2) Delayed LC Group. Both groups were compared in terms of operation timing, operative difficulty, intra/post-operative complications, conversion to open cholecystectomy, mortality, total length of stay (LOS) in the hospital, and recurrent biliary events (RBEs).

Results:  Mean LOS (days)in Early LC Group was 6.5±1.1 and in the Delayed LC Group was 9.7±1.8(p-value<0.001). No RBE occurred in Early LC Group, however, 15 patients in Delayed LC Group had RBEs (p-value<0.001). No statistically significant difference was observed between the two groups in terms of operative difficulty, intra/post-operative complications, and conversion to open cholecystectomy.

Conclusion: Early LC done for mild/moderate ABP is associated with reduced total LOS in the hospital and no RBEs. There was no statistically significant difference observed between Early LC and Delayed LC in terms of operative difficulty, intra/post-operative complications, and conversion to open cholecystectomy.

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References

1. Zerem E, Kurtcehajic A, Kunosić S, Zerem Malkočević D, Zerem O. Current trends in acute pancreatitis: Diagnostic and therapeutic challenges. World J Gastroenterol 2023; 29(18): 2747-2763. https://doi:10.3748/wjg.v29.i18.2747

2. Petrov MS, Yadav D. Global epidemiology and holistic prevention of pancreatitis. Nat Rev Gastroenterol Hepatol 2019;16(3): 175-184. https://doi:10.1038/s41575-018-0087-5

3. Han C, Yang HY, Lv YW, et al. Global status of acute pancreatitis research in the last 20 years: A bibliometric study. Medicine 2022; 101(41): e31051.

https://doi:10.1097/MD.0000000000031051

4. Zhong FP, Wang K, Tan XQ, Nie J, Huang WF, Wang XF. The optimal timing of laparoscopic cholecystectomy in patients with mild gallstone pancreatitis: A meta-analysis. Medicine 2019; 98(40): e17429. https://doi.org/10.1097/md.0000000000017429

5. van Geenen EJ, van der Peet DL, Bhagirath P, Mulder CJ, Bruno MJ. Etiology and diagnosis of acute biliary pancreatitis. Nat Rev Gastroenterol Hepatol 2010; 7(9): 495-502.

https://doi:10.1038/nrgastro.2010.114

6. Colvin SD, Smith EN, Morgan DE, Porter KK. Acute pancreatitis: an update on the revised Atlanta classification. Abdom Radiol 2020; 45(5): 1222-1231.

https://doi:10.1007/s00261-019-02214-w

7. Basit H, Ruan GJ, Mukherjee S. Ranson Criteria(Archived). 2022 Sep 26. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan–.

8. Gapp J, Tariq A, Chandra S. Acute Pancreatitis. [Updated 2023 Feb 9]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-Available from:

https://www.ncbi.nlm.nih.gov/books/NBK482468

9. Kanaparthy NS, Loza AJ, Hauser RG. Crawling toward obsolescence: The extended lifespan of amylase for pancreatitis. PLoS One. 2023 Dec 21; 18(12): e0296180.

https://doi:10.1371/journal.pone.0296180

10. Blundell JD, Gandy RC, Close JCT, Harvey LA. Time to interval cholecystectomy and associated outcomes in a population aged 50 and above with mild gallstone pancreatitis. Langenbecks Arch Surg 2023; 408(1): 380.

https://doi:10.1007/s00423-023-03098-7

11. Sumbizi C, Obwar A, Rofaeil B, Fidaali Z, Ali A, Mwanga A. Simultaneous endoscopic and laparoscopic management of acute biliary pancreatitis in the second trimester of pregnancy: A case report. Int J Surg Case Rep 2025; 133: 111589.

https://doi:10.1016/j.ijscr.2025.111589

12. Griffiths EA, Hodson J, Vohra RS, Marriott P; et al. Utilization of an operative difficulty grading scale for laparoscopic cholecystectomy. Surg Endosc 2019; 33(1): 110-121.

https://doi:10.1007/s00464-018-6281-2.

13. Vannucci M, Laracca GG, Mercantini P, Perretta S, Padoy N, Dallemagne B, Mascagni P. Statistical models to preoperatively predict operative difficulty in laparoscopic cholecystectomy: A systematic review. Surgery 2022; 171(5): 1158-1167.

https://doi:10.1016/j.surg.2021.10.001.

14. Bergeron E, Doyon T, Manière T, Désilets É. Delay for cholecystectomy after common bile duct clearance with ERCP is just running after recurrent biliary event. Surg Endosc 2023; 37(12): 9546-9555. https://doi:10.1007/s00464-023-10423-0

15. Alburakan AA, Alshunaifi AI, AlRabah RN, et al. Early versus delayed cholecystectomy in biliary pancreatitis: Experience from a Local Acute Care Surgery Unit in Saudi Arabia. Medicine 2023; 102(48): e36491. https://doi:10.1097/MD.0000000000036491

16. Aksoy F, Demiral G, Ekinci Ö. Can the timing of laparoscopic cholecystectomy after biliary pancreatitis change the conversion rate to open surgery? Asian J Surg 2018; 41(4): 307-312.

https://doi:10.1016/j.asjsur.2017.02.001.

17. Guadagni S, Cengeli I, Palmeri M, Bastiani L, Bertolucci A, Modesti M, et al. Early cholecystectomy for non-severe acute gallstone pancreatitis: easier said than done. Minerva Chir 2017; 72(2): 91-97. https://doi:10.23736/S0026-4733.16.07176-5

18. Mencarini L, Vestito A, Zagari RM, Montagnani M. The Diagnosis and Treatment of Acute Cholecystitis: A Comprehensive Narrative Review for a Practical Approach. J Clin Med 2024; 13(9): 2695. https://doi:10.3390/jcm13092695

19. Qi S, Xu J, Yan C, He Y, Chen Y. Early versus delayed laparoscopic cholecystectomy after endoscopic retrograde cholangiopancreatography: A meta-analysis. Medicine 2023; 102(36): e34884. https://doi:10.1097/MD.0000000000034884

20. Seppänen H, Puolakkainen P. Classification, Severity Assessment, and Prevention of Recurrences in Acute Pancreatitis. Scand J Surg 2020; 109(1): 53-58.

https://doi:10.1177/1457496920910007

21. Leppäniemi A, Tolonen M, Tarasconi A, Segovia-Lohse H, Gamberini E, et al. 2019 WSES guidelines for the management of severe acute pancreatitis. World J Emerg Surg 2019; 14:27.

https://doi:10.1186/s13017-019-0247-0

22. Walayat S, Baig M, Puli SR. Early vs late cholecystectomy in mild gall stone pancreatitis: An updated meta-analysis and review of literature. World J Clin Cases 2021; 9(13): 3038-3047.

https://doi:10.12998/wjcc.v9.i13.3038

Published

15-07-2026

Issue

Section

Original Articles

How to Cite

1.
Siddique MU, Wattoo NM, Hira, Khan TM, Muhammad Naeem, Adil Maqbool. Role of Early Elective Cholecystectomy in Acute Mild-To-Moderate Biliary Pancreatitis. Pak Armed Forces Med J [Internet]. 2026 Jul. 15 [cited 2026 Jul. 22];76(SUPPL-7). Available from: https://www.pafmj.org/PAFMJ/article/view/11955