Outcomes of Early Versus Delayed Cholecystectomy in Acute Gallstone Pancreatitis: A Systematic Review and Meta-Analysis.

Acute pancreatitis is an inflammatory condition of the exocrine pancreas that can cause severe abdominal pain, pancreatic necrosis, and prolonged organ failure, most commonly caused by gallstones and alcohol use. This study aims to evaluate and compare the outcomes of early and delayed cholecystectomy in adult patients with mild acute gallstone pancreatitis, focusing on postoperative mortality, complications, length of hospital stay, and recurrence rate. We searched Web of Science, PubMed, and the Cochrane Library for studies published from 2014 to 2025. We included studies enrolling adult patients diagnosed with acute gallstone pancreatitis, confirmed by laboratory tests and imaging. Primary outcomes included postoperative mortality, complications, and length of hospital stay, while secondary outcomes included recurrence of pancreatitis and the need for endoscopic retrograde cholangiopancreatography (ERCP). Five studies involving a total of 393 participants were included; most were retrospective cohort studies except for one prospective randomized controlled trial. Mortality was 0% in all studies, except for one death in the delayed group due to postoperative heart failure. Subgroup analysis showed no significant difference in surgical site infection between early and delayed groups (risk ratio (RR) = 0.96), and the overall postoperative complication rate was also not significantly different (RR = 0.78). Length of hospital stay was significantly shorter in the early group (mean difference (MD) = -2.68 days). The need for ERCP showed no significant difference between groups (RR = 0.94), while the recurrence rate was significantly lower in the early group (RR = 0.05). This review shows that early cholecystectomy is more effective than delayed cholecystectomy in decreasing both the length of hospital stay and the risk of recurrent pancreatitis in patients with acute gallstone pancreatitis, while postoperative complications, including surgical site infection and need for ERCP, did not differ between groups.