Cholecystectomy 7 days vs 4 weeks after mild biliary pancreatitis; looking a decrease the incidence of persistent choledocholithiasis and ERCP: A multicentric randomized clinical trial.

Autor: Facundo HG; General and Digestive Surgery Department, Moisès Broggi Hospital, CSI, Barcelona, Spain General and Digestive Surgery Department, Sant Joan de Déu Hospital, Martorell, Barcelona, Spain General and Digestive Surgery Department, Joan XXIII Hospital, Tarragona, Spain General and Digestive Surgery Department, Consorci Sanitari Garraf, Sant Pere de Ribes, Barcelona, Spain General and Digestive Surgery Department, Consorci Sanitari Vic, Vic, Barcelona, Spain General and Digestive Surgery Department, Dos de Maig Hospital, Barcelona, Spain Epidemiology Department, Moisès Broggi Hospital, CSI, Barcelona, Spain., Montoliu RR, Llanos DRC, Naval GS, Millán EL, Gordo SL, Bosch JH, Rodríguez SL, Baranera MM, Martínez SG
Jazyk: angličtina
Zdroj: International journal of surgery (London, England) [Int J Surg] 2022 Feb; Vol. 98, pp. 106207. Date of Electronic Publication: 2022 Jan 04.
DOI: 10.1016/j.ijsu.2021.106207
Abstrakt: Background: Mild acute biliary pancreatitis (MABP) requires definitive treatment of the cholelithiasis to avoid recurrent biliary events. Recent publications recommend performing early surgery to prevent readmissions. However, an exceedingly early cholecystectomy could imply missing the presence of persistent choledocholithiasis or requiring a significant number of preoperative endoscopic retrograde cholangiopancreatographies (ERCP). This multicentre randomized clinical trial compares early surgery performed a week after MABP with delayed surgery (at 4 weeks), to compare readmission rates for recurrent biliary events and the incidence of residual choledocholithiasis between the two groups.
Materials and Methods: A total of 198 patients with a first episode of MABP defined by the Atlanta 2012 criteria were enrolled. Randomization was done by a central study coordinator: 98 to early surgery and 100 to delayed surgery. All of them had preoperative or intraoperative imaging to exclude persistent choledocholithiasis. Laparoscopic cholecystectomy was performed by dedicated teams of experienced surgeons.
Results: Early surgery reduced the rate of readmissions for biliary events before cholecystectomy by half (7.2% vs 15.8%, p = 0,058). There were no differences in the type of surgery, postoperative stay, or complications compared with delayed surgery. Choledocholithiasis was observed in 9.0% of patients in the early group and 7.7% in the delayed group (p 0,719). The preoperative or intraoperative imaging study avoided unnecessary ERCP, which was performed in only 6 (3%) patients.
Conclusions: Early cholecystectomy performed seven days after resolution of MABP had a low incidence of recurrent biliary events and complications, and was not associated with an increase in residual choledocholithiasis or need for unnecessary ERCP.
(Copyright © 2022 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
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