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Early cholecystectomy for mild gallstone pancreatitis shortens LOS

Clinical Question:
Does early cholecystectomy reduce the length of hospital stay for patients presenting with mild gallstone pancreatitis?

Bottom Line:
In patients with mild gallstone pancreatitis, cholecystectomy performed within 48 hours of presentation, despite persistent abnormal laboratory values or abdominal pain, shortens length of stay (LOS) without adversely affecting outcomes. (LOE = 1b)

Reference:
Aboulian A, Chan T, Yaghoubian A, et al. Early cholecystectomy safely decreases hospital stay in patients with mild gallstone pancreatitis. Ann Surg 2010;251:615-619.  [PMID:20101174]

Study Design:
Randomized controlled trial (nonblinded)

Funding:
Unknown/not stated

Allocation:
Concealed

Setting:
Inpatient (ward only)

Synopsis:
In this small study, investigators recruited adult patients presenting with mild gallstone pancreatitis who were admitted to a nonmonitored hospital ward. Excluded patients were those with severe pancreatitis indicated by a Ranson score higher than 3 on admission, those with a suspected retained common bile duct stone, or those with suspected acute cholangitis. Patients were randomized, using concealed allocation, to an early group (n = 25) in which laparoscopic cholecystectomy (LC) and intraoperative cholangiography (IOC) was performed within 48 hours, or to a control group (n = 25) in which LC and IOC were performed only after resolution of abdominal pain and normalization of laboratory values. Patients in both groups had similar baseline characteristics, including age, presence of co-morbidities, and duration of symptoms on presentation. The median Ranson score on admission was 1 in both groups. In the early group, patients underwent surgery at a mean of 35.1 hours after admission as compared with 77.8 hours in the control group (P < .001). All surgeries were performed laparoscopically. One patient in the control group developed respiratory failure prior to any planned procedures which required prolonged intensive care unit hospitalization, and was excluded from the analysis. Patients in the early cholecystectomy group had a shorter overall LOS than patients in the control group (3.5 days vs 5.8 days; P = .0016). There was no significant difference detected between the 2 groups in the need for endoscopic retrograde cholangiography. Furthermore, none of the patients in either group experienced any perioperative complications, such as bile duct injury, bleeding requiring transfusion, wound infection, pneumonia, or 30-day readmission.

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