Timing of Cholecystectomy After Acute Biliary Severe Pancreatitis: A Systematic Review-Time for A Clinical Trial?

Abstract

Background: There is a lack of evidence about the optimal timing for cholecystectomy in patients with severe acute pancreatitis. The discussion centers on evaluating the benefits of performing early versus delayed cholecystectomy, looking for better outcomes. This systematic review aimed to assess the postoperative outcomes after cholecystectomy in patients with severe pancreatitis regarding the timing of the surgery.

Methods: A systematic review was conducted, and the inclusion criteria included original, peer-reviewed retrospective or prospective studies involving humans > 18 years old with acute severe pancreatitis due to gallstone disease who underwent laparoscopic cholecystectomy. Newcastle Ottawa score was used to perform quality and bias assessment. The search was conducted from January 2004 to December 2023 within Pubmed, EMBASE, and Scopus.

Results: A total of 1198 studies were found; after screening for duplicates, eligibility criteria and conducting quality assessment, three articles met the inclusion criteria and were included in the systematic review, involving a total of 598 patients. Early cholecystectomy (Defined < 15 days or 6 weeks) was performed in 30.10% (n = 179) and delayed cholecystectomy in 70.06% (n = 419), with a morbidity rate of 33% (n = 60) and 20% (n = 86), respectively. Mortality was most frequent when cholecystectomy was performed earlier (2.39% n = 10 vs. 0.23% n = 1).

Conclusion: Despite limitations regarding the small sample size and the small amount of research published to date, this systematic review suggests that there is a higher risk of morbidity and mortality in patients with severe pancreatitis undergoing early cholecystectomy compared to those undergoing delayed cholecystectomy.