Early Laparoscopic Cholecystectomy for Acute Gallstone Pancreatitis: Retrospective Review of Factors Influencing Timing of Surgery and Outcomes in a Single Institution.

Introduction Early laparoscopic cholecystectomy (ELC) is considered best practice in the treatment of acute gallstone pancreatitis. However, there is debate regarding the timing of surgery during the index admission. We reviewed some of the factors that can help determine the timing of early cholecystectomy, and its impact on patient outcomes. Methods Electronic medical records were retrospectively reviewed for all adult patients with acute gallstone pancreatitis who underwent laparoscopic cholecystectomy during the same admission over a two-year period at a tertiary centre. Patient outcomes and complication rates were compared based on whether they met our preoperative study criteria of being opioid-free, tolerating a solid diet, and having a serum C-reactive protein (CRP) level ≤100mg/L. Results A total of 199 patients were included in our study, of whom 83 (42%) met all three of our preoperative criteria, while the remaining 116 (58%) did not meet at least one of these criteria. The median time to surgery was four days (interquartile range (IQR) 3-6) and median length of stay was six days (IQR 4-8), which was similar between the two study groups. There was no significant difference found in rates of postoperative surgical site infection, haematoma, bile leak, and intra-abdominal collection. There were also similar rates of further interventions, including endoscopic retrograde cholangiopancreatography (ERCP) and interventional radiology. There was no postoperative venous thromboembolism or mortality reported in either study group. Conclusion This study highlights the relatively low complication rates of ELC for acute gallstone pancreatitis, as well as some of the difficulty in determining the appropriate time to proceed to ELC during the index admission. While patient factors (e.g. diet tolerance and pain level) and biochemical markers (e.g. serum CRP level) have been considered as indicators of readiness for surgery, using these has not necessarily demonstrated significant differences in patient outcomes or complication rates. It should therefore be considered whether ELC can be safely performed without waiting for all of these preoperative factors to be met, which would likely lead to a reduced hospital stay and, therefore, potentially reduced individual healthcare costs.