Impact of acute pancreatitis on the outcomes of cholecystectomy. An observational multicenter retrospective study.

Abstract

Purpose: Gallstones are the most common cause of acute pancreatitis (AP), which usually necessitate hospitalization. Although cholecystectomy is required to prevent recurrent episodes, no clear guidelines have been established yet regarding the proper timing of cholecystectomy after an AP incidence. The objective was to evaluate the impact of AP on the course of cholecystectomy procedures, both by comparing patients with and without a history of AP and by analyzing the AP subgroup according to timing and severity.

Methods: This retrospective evaluation was performed on patients who had undergone cholecystectomy for various causes in six hospitals in Poland. Patients were divided into the following three groups: patients without AP, patients with a history of AP, and patients with active AP. The analyzed variables included the surgical type and duration, postoperative complications, AP severity, and time elapsed between cholecystectomy and AP treatment completion.

Results: In total, 4183 patients were included in the study, including 3948 without AP, 209 with a history of AP, and 26 with active AP. The most common surgical indications in patients with active AP and history of AP were concomitant cholecystitis (53.85%) and cholelithiasis (82.3%), respectively. The mean complication rates were not significantly different between groups. The surgical type was significantly affected by AP severity. Surgery in the period between 15 and 31 days post-AP attack was associated the highest frequency of minimally invasive surgery and shortest surgical duration, although the differences were not significant.

Conclusion: Inflammation is the most common associated cause of surgery during the course of active AP. Surgery at 15-31 days post-AP attack was associated with a higher frequency of minimally invasive surgery and shorter operative duration, although these differences did not reach statistical significance. Our findings therefore suggest, but do not confirm, that this may represent a favorable time window, which warrants further evaluation in prospective studies.