Do patients with mild gallstone pancreatitis who undergo early cholecystectomy have better outcomes than patients who undergo delayed surgery?

Patients with mild gallstone pancreatitis who undergo cholecystectomy during the index hospitalization are better off than those who delay surgery for at least 2 weeks after discharge. Although there were only 5 studies and 629 patients in this meta-analysis, the quality of the studies and the consistency of findings across the studies lends confidence to the results. (LOE = 1a)

Moody N, Adiamah A, Yanni F, Gomez D. Meta-analysis of randomized clinical trials of early versus delayed cholecystectomy for mild gallstone pancreatitis. Br J Surg 2019;106(11):1442-1451.  [PMID:31268184]

Meta-analysis (randomized controlled trials)

Government

Various (meta-analysis)

These authors searched EMBASE, MEDLINE, and Cochrane databases to identify randomized trials of early versus delayed cholecystectomy in patients with mild gallstone pancreatitis. Since there is no standard definition, the authors declared that early surgery occurred during the index hospitalization and delayed surgery occurred at least 2 weeks after discharge from the index hospitalization. Two authors independently assessed articles for inclusion and used a third author to adjudicate disagreements. Although they don't describe searching for unpublished studies, they reported funnel plots that suggest little risk of publication bias. They also used the Cochrane risk of bias domains to assess the methodologic quality of the included studies. Ultimately, they included 5 trials with 629 patients. The studies entailed an overall low risk of bias. Each of the included studies had different definitions of mild gallstone pancreatitis, but all were generally sensible. Only 10 of the 318 patients who underwent early surgery required readmission compared with 61 of 311 patients who underwent delayed surgery (3.1% vs 19.6%, respectively; number needed to treat [NNT] = 7; 95% CI 5 - 9). The rates of intra-operative complications (~ 2%) and postoperative complications (~ 5%) were similar in both groups. The early surgery group also had a much lower rate of biliary events not requiring hospitalization than the delayed surgery group (1% vs 35%, respectively; NNT= 3; 2 - 4). All of the studies reported all-cause mortality, but there was only one death reported (which is not surprising given the small number of patients). Finally, the authors found negligible heterogeneity among the data.