EARLY LAPAROSCOPIC CHOLECYSTECTOMY IN GALLSTONE PANCREATITIS

F ASHFAQ; K IQBAL; S Ashfaq

doi:10.54112/bcsrj.v2024i1.2290

Authors

F ASHFAQ Department of General Surgery, Aziz Bhatti Shaheed Teaching Hospital, Gujrat, Pakistan
K IQBAL Department of General Surgery, Aziz Bhatti Shaheed Teaching Hospital, Gujrat, Pakistan
S Ashfaq Services Institute of Medical Sciences

DOI:

https://doi.org/10.54112/bcsrj.v2024i1.2290

Keywords:

Cholelithiasis, Gallstones, Laparoscopic cholecystectomy, Outcome, Pancreatitis

Abstract

Gallstones are one of the major causes of “acute pancreatitis” and thus “laparoscopic cholecystectomy” should be planned to remove these stones. However, timing of surgery has been a topic of debate and it is still unclear that which option provides better outcomes. Objectives: To compare the outcomes of early versus delayed laparoscopic cholecystectomy in gallstone pancreatitis. Methods: This two-phase quasi-experimental study was conducted at the Department of General Surgery, Nawaz Sharif Medical College / Aziz Bhatti Shaheed Teaching Hospital, Gujrat, Pakistan from May 2024 till August 2024. A total of 78 patients admitted with “acute gallstone pancreatitis” were included. Half of the patients in first phase of the study underwent “early laparoscopic cholecystectomy” while remaining half in second phase of the study underwent “delayed laparoscopic cholecystectomy”. Outcomes between both the groups were compared. Data was analyzed through SPSS version 20. Results: Mean age was 42.97 ± 5.68 years. There were 15 (19.23%) male and 63 (80.77%) female patients. Mean BMI was 32.95 ± 4.98 kg/m2. Mean operative time in “early LC” group was 76.28 ± 9.71 minutes while in “delayed LC” group, it was 86.43 ± 9.80 minutes (p < 0.001). There was significantly less frequency of presence of adhesions in the operative field (p = 0.01) and intra-operative bleeding (0.05) in “early LC” group. Mean hospitalization length in “early LC” group was 6.71 ± 1.33 days while in “delayed LC” group, it was 12.33 ± 3.08 days (p < 0.001). Frequency of recurrent pancreatitis in “early LC” group was significantly less as compared to “delayed LC” group, (p = 0.002). Conclusion: “Early laparoscopic cholecystectomy” is a safer and better surgical option as compared to “delayed laparoscopic cholecystectomy” for management of “gallstone pancreatitis”.

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References

1. Ingraham, N. E., King, S., Proper, J., Siegel, L., Zolfaghari, E. J., Murray, T. A., Vakayil, V., Sheka, A., Feng, R., Guzman, G., Roy, S. S., Muddappa, D., Usher, M. G., Chipman, J. G., Tignanelli, C. J., & Pendleton, K. M. (2021). Morbidity and mortality trends of pancreatitis: an observational study. Surgical infections, 22(10), 1021–1030. DOI: https://doi.org/10.1089/sur.2020.473

2. Patel, M. L., Shyam, R., Atam, V., Bharti, H., Sachan, R., & Parihar, A. (2022). Clinical profile, etiology, and outcome of acute pancreatitis: Experience at a tertiary care center. Annals of African medicine, 21(2), 118–123. DOI: https://doi.org/10.4103/aam.aam_83_20

3. Irum, R. & Yousaf, M. (2021). Diagnostic accuracy of ultrasonography in diagnosing acute pancreatitis, taking computed tomography as gold standard. Journal of Sharif Medical and Dental College, 7(1), 30-36.

4. Sendler, M., & Algül, H. (2021). Pathogenese der akuten Pankreatitis [Pathogenesis of acute pancreatitis]. Der Internist, 62(10), 1034–1043. DOI: https://doi.org/10.1007/s00108-021-01158-y

5. Aggarwal, A., Mathur, A.V., Verma, R.K., Gupta, M. & Raj, D. (2020). Comparison of BISAP and Ranson’s score for predicting severe acute pancreatitis and establish the validity of BISAP score. International Surgery Journal, 7(5), 1473-1480. DOI: https://doi.org/10.18203/2349-2902.isj20201854

6. Assakran, B. S., Khalid, R., Albadrani, H., Alsuhaibani, A., Almutairi, A., Alhomidan, R., Alfarhan, G., & Alshaya, R. (2023). Incidence of asymptomatic gallstones in obese patients who underwent bariatric surgery in Qassim Region at King Fahad Specialist Hospital. Cureus, 15(8), e44154. DOI: https://doi.org/10.7759/cureus.44154

7. Khan, I., Yadav, P., Saran, R. K., Sharma, S., & Sharma, A. K. (2023). A study of the degree of gall bladder wall thickness and its impact on patients undergoing laparoscopic cholecystectomy. Cureus, 15(5), e38990. DOI: https://doi.org/10.7759/cureus.38990

8. Akram, M., Arsalan, M., Kumar, V., Ahmed, M., Rizwan, M., Iqbal, W. & Abbas, K. (2022). Outcome of laparoscopic cholecystectomy in acute pancreatitis secondary to gallstones: a prospective observational study from Pakistan. Liaquat National Journal of Primary Care, 2022, 4.

9. Walayat, S., Baig, M., & Puli, S. R. (2021). Early vs late cholecystectomy in mild gall stone pancreatitis: An updated meta-analysis and review of literature. World journal of clinical cases, 9(13), 3038–3047. DOI: https://doi.org/10.12998/wjcc.v9.i13.3038

10. Randial Pérez, L. J., Fernando Parra, J., & Aldana Dimas, G. (2014). Seguridad de la colecistectomía laparoscópica temprana (<48 h) para pacientes con pancreatitis aguda biliar leve: revisión sistemática de la literatura y metaanálisis [The safety of early laparoscopic cholecystectomy (<48 hours) for patients with mild gallstone pancreatitis: a systematic review of the literature and meta-analysis]. Cirugia espanola, 92(2), 107–113. DOI: https://doi.org/10.1016/j.ciresp.2013.01.024

11. Eğin, S., Yeşiltaş, M., Gökçek, B., Tezer, H., & Karahan, S. R. (2017). Early laparoscopic cholecystectomy following acute biliary pancreatitis expedites recovery. Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES, 23(6), 495–500. DOI: https://doi.org/10.5505/tjtes.2017.50128

12. ElSayed, N. A., Aleppo, G., Aroda, V. R., Bannuru, R. R., Brown, F. M., Bruemmer, D., Collins, B. S., Hilliard, M. E., Isaacs, D., Johnson, E. L., Kahan, S., Khunti, K., Leon, J., Lyons, S. K., Perry, M. L., Prahalad, P., Pratley, R. E., Seley, J. J., Stanton, R. C., Gabbay, R. A., … on behalf of the American Diabetes Association (2023). 2. Classification and diagnosis of diabetes: standards of care in diabetes-2023. Diabetes care, 46(Suppl 1), S19–S40. DOI: https://doi.org/10.2337/dc23-S002

13. Szatmary, P., Grammatikopoulos, T., Cai, W., Huang, W., Mukherjee, R., Halloran, C., Beyer, G., & Sutton, R. (2022). Acute pancreatitis: diagnosis and treatment. Drugs, 82(12), 1251–1276. DOI: https://doi.org/10.1007/s40265-022-01766-4

14. Finch, B. J., Robinson, P. D., & Wakefield, C. H. (2022). What you need to know about gallstone disease. British journal of hospital medicine (London, England : 2005), 83(12), 1–8. DOI: https://doi.org/10.12968/hmed.2022.0351

15. Kundumadam, S., Fogel, E. L., & Gromski, M. A. (2021). Gallstone pancreatitis: general clinical approach and the role of endoscopic retrograde cholangiopancreatography. The Korean journal of internal medicine, 36(1), 25–31. DOI: https://doi.org/10.3904/kjim.2020.537

16. Isogai M. (2024). Pathophysiology of severe gallstone pancreatitis: A new paradigm. World journal of gastroenterology, 30(7), 614–623. DOI: https://doi.org/10.3748/wjg.v30.i7.614

17. Jadoon, S., Nawaz, M., Javed, S., Imtiaz, H., Jadoon, O., & Taimoor, A. (2021). Study on the prevalence of gallstones in patients undergoing cholecystectomy in Benazir Bhutto Shaheed Hospital (DHQ) Abbottabad. Journal of Ayub Medical College, Abbottabad, 33(1), 102–104.

18. Song, Y., Ma, Y., Xie, F. C., Jin, C., Yang, X. B., Yang, X., Long, J. Y., Wang, D. X., Sang, X. T., Li, L. M., Zhao, H. T., & Ning, Y. (2022). Age, gender, geographic and clinical differences for gallstones in China: a nationwide study. Annals of translational medicine, 10(13), 735. DOI: https://doi.org/10.21037/atm-21-6186

19. Salari, N., Hasheminezhad, R., Heidarisharaf, P., Khaleghi, A. A., Azizi, A. H., Shohaimi, S., & Mohammadi, M. (2023). The global prevalence of gallstones in pregnancy: A systematic review and meta-analysis. European journal of obstetrics & gynecology and reproductive biology: X, 19, 100237. DOI: https://doi.org/10.1016/j.eurox.2023.100237

20. Parra-Landazury, N. M., Cordova-Gallardo, J., & Méndez-Sánchez, N. (2021). Obesity and gallstones. Visceral medicine, 37(5), 394–402. DOI: https://doi.org/10.1159/000515545

21. Kuan, L. L., Dennison, A. R., & Garcea, G. (2020). Association of visceral adipose tissue on the incidence and severity of acute pancreatitis: A systematic review. Pancreatology: official journal of the International Association of Pancreatology (IAP), 20(6), 1056–1061. DOI: https://doi.org/10.1016/j.pan.2020.05.027

22. Murphy, M. C., Gibney, B., Gillespie, C., Hynes, J., & Bolster, F. (2020). Gallstones top to toe: what the radiologist needs to know. Insights into imaging, 11(1), 13. DOI: https://doi.org/10.1186/s13244-019-0825-4

23. Chandak, U., Pind, V., Mitra, A., Bansod, P.Y., Gaikwad, U. & Ramteke, P. (2022). Early versus late laparoscopic cholecystectomy in acute biliary pancreatitis: a prospective randomised study. International Surgery Journal, 9(9), 1558-1565. DOI: https://doi.org/10.18203/2349-2902.isj20222059

24. Riquelme, F., Marinkovic, B., Salazar, M., Martínez, W., Catan, F., Uribe-Echevarría, S., Puelma, F., Muñoz, J., Canals, A., Astudillo, C., & Uribe, M. (2020). Early laparoscopic cholecystectomy reduces hospital stay in mild gallstone pancreatitis. A randomized controlled trial. HPB : the official journal of the International Hepato Pancreato Biliary Association, 22(1), 26–33. DOI: https://doi.org/10.1016/j.hpb.2019.05.013

25. Sharma, A., Madapu, A., Rakholiya, J., Sharma, S. & Jha, A. (2021). Early versus late laparoscopic cholecystectomy in patients with acute gallstone pancreatitis. SN Comprehensive Clinical Medicine, 3, 590–599. DOI: https://doi.org/10.1007/s42399-021-00765-y

26. Iqbal, T., Fater, B.B. & Ali, S. (2024). Knowledge, attitude and practice of nurses regarding infection control in operation theater in secondary care hospital. Menoufia Medical Journal, 37(2), 5. DOI: https://doi.org/10.59204/2314-6788.3055