Abstract
Objectives: The aim of our study was to compare the outcome of early (<2 weeks) versus delayed (>2weeks) laparoscopic cholecystectomy in patients of mild and moderate acute gallstone pancreatitis.
Methods: The present study was carried for a period of two years (2012-2013).The study was a prospective one, and the admitted patients were stabilized, conservative management was continued till patients clinical profile, laboratory and biochemical parameters indicate termination of acute attack of pancreatitis, and CT was done within 48 hours of admission. After termination of acute attack of pancreatitis patients were randomly allocated into two groups using proper statistical technique viz. Group A and Group B. Group A included the patients of mild and moderate gallstone pancreatitis in whom early laparoscopic cholecystectomy was performed (within two weeks of index admission), Group B included the patients of mild and moderate gallstone pancreatitis in whom delayed laparoscopic cholecystectomy was performed (after two weeks of index admission). Any CBD stone detected preoperatively was subjected to endoscopic retrieval before taking up the patient for surgery. The two groups were compared as per the preset proforma and the difference between the two groups was statistically analyzed. The end point of study was follow-up upto one year.
Results: In each group 40 patients were operated via 4 port laparoscopic cholecystectomy. The mean age in Group A was 41.9±10.24 years and in Group B was 42.025±10.56 years, p-value=0.957. The cases were included in the study irrespective of their sex. Out of 80 cases 7 and 9 were males in Group A and B respectively and 33 and 31 were females in Group A and B respectively, p-value = 0.576. Modified CECT severity index was used to assess severity of acute pancreatitis, Group A had a mean score of 3.1±1.19 and Group B had mean score of 3.2±1.27 p-value=0.857 and there was no statistically significant difference between two groups. ERCP was used before taking up cases for surgery where CBD calculi where detected. 15% in Group A and 20% in Group B underwent pre-operative ERCP and the difference was statistically not significant p-value=0.769. There was no recurrence of pancreatitis and cholecystitis in group A, however 15% cases of group B had recurrent pancreatitis or cholecystitis, p-value 0.02.There was no mortality in our study in either of the two groups. Morbidity was studied in terms of intraoperative and postoperative complications in a preset proforma. Intraoperatively there was no visceral, diaphragmatic or CBD injury in either groups, however 2 (5%) cases of Group A and 1 (2.5%) cases in Group B had intraoperative bleeding but the difference was not statistically significant. Postoperatively 11 complications were met in Group A and 8 complications were met in Group B but results were not statistically significant. The hospital stay and loss of work days was significantly shorter in Group A cases in comparison with Group B cases p-value <.0001.
Conclusion: Early laparoscopic cholecystectomy is best to prevent recurrent attacks of pancreatitis and cholecystitis and it reduces the total hospital stay and loss of work days without increasing the intraoperative and post operative morbidity.
Keywords: Gallstones, pancratitis, early cholecystectomy, delayed cholecystectomy.
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DOI: http://dx.doi.org/10.18535/jmscr/v3i8.44
