Results of Early Vs. Delayed Cholectectomy in Patients with Acute Gallstone Pancreatitis

Abstract

Background: According to research studies, gallstone-related diseases are the cause of about 75% of acute pancreatitis cases in well-developed countries. When there is constant biliopancreatic obstruction, there is progressive inflammation of the pancreas. This is how we can explain the pathogenesis of Acute Gallstone Pancreatitis (AGP). There might be repeating events of common bile duct obstruction, acute pancreatitis, self-limiting biliary colic, or acute cholangitis. AGP episodes are typically moderate and self-limiting. Nevertheless, 10% - 20% of patients develop acute pancreatitis, which has a significant mortality and morbidity rate. Objective: For patients having an early or delayed cholecystectomy following an episode of mild to moderate acute AGP, this study compares the time duration of the operation, perioperative complications, conversion rate, time duration of hospital stay, and rate of gallstone-related recurring problems. Study design: A Randomized Controlled Trial Place and Duration: This study was conducted in Federal General Hospital Islamabad Pakistan from March 2022 to March 2023. Methodology: The participants in this research were those who were diagnosed with mild to moderate acute gallstone pancreatitis. Patient with complication (pancreatic necrosis, pseudocyst pancreatic abscess)  following pancreatitis were excluded All the individuals were aged between 18 and 75 years. The participants were randomly put into either a delayed cholecystectomy group (DC) or an Early Cholecystectomy group (EC). Laparoscopic cholecystectomy was performed in both groups. A pre-designed form was used to collect data regarding progress before surgery, during surgery, and after surgery. Results: There were a total of 100 people who met the inclusion criteria of our research from the Department of Surgery. All the individuals were aged from 18 years to 75 years. The average age calculated was 45.01 years. The participants were randomly placed in both groups and were equally divided (50 people in each group). The median time duration from diagnosis of acute gallstone pancreatitis to Laparoscopic Cholecystectomy (LC) was 7 days in the early cholecystectomy (EC) group, while it was 28 days in the delayed cholecystectomy (DC) group. There were a total of 8 people who were converted to open surgery, 5 in the EC group and 3 in the DC group. There were a total of 15 recurrent biliary events. Conclusion: DC was associated with a higher likelihood of recurring biliary episodes and hospital readmissions. This leads to increased patient morbidity and healthcare expenses.