Timing of cholecystectomy for biliary pancreatitis: do the data support current guidelines?

J Gastrointest Surg. 2008 Dec;12(12):2164-70. doi: 10.1007/s11605-008-0603-y. Epub 2008 Jul 18.


Background: Current guidelines suggest that cholecystectomy be performed within 2 weeks after discharge following an episode of biliary pancreatitis. We hypothesized that a high incidence of gallstone-related events is present within 2 weeks after discharge prior to cholecystectomy.

Methods: Two hundred eighty-one patients who underwent cholecystectomy for biliary pancreatitis (January 1999-December 2005) were categorized into one of two groups: group A patients underwent cholecystectomy during index admission (n = 162), and group B patients underwent cholecystectomy following discharge from index admission (n = 119).

Results: Groups were comparable in demographics, comorbidities, and disease severity. Thirty-nine (32.8%) group B patients experienced pre-cholecystectomy gallstone-related events (including 16 cases of recurrent pancreatitis) after discharge. Recurrences (31.3%) occurred within 2 weeks after discharge. Endoscopic sphincterotomy protected against preoperative recurrent pancreatitis but was associated with a higher incidence of other gallstone-related events. Median total length of hospital stay was greater for group B than for group A [7 (range, 2-37) days vs. 5 (1-45) days, respectively, p = 0.00].

Conclusion: Current guidelines suggesting the appropriateness of waiting up to 2 weeks for cholecystectomy for biliary pancreatitis may place patients at unacceptably high risk for recurrence. Endoscopic sphincterotomy does not eliminate the risk of gallstone-related events.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Chi-Square Distribution
  • Cholangiopancreatography, Endoscopic Retrograde
  • Cholecystectomy*
  • Cholecystectomy, Laparoscopic
  • Comorbidity
  • Female
  • Gallstones / complications*
  • Gallstones / diagnostic imaging
  • Gallstones / epidemiology
  • Gallstones / surgery*
  • Humans
  • Incidence
  • Length of Stay / statistics & numerical data
  • Male
  • Middle Aged
  • Pancreatitis / complications*
  • Pancreatitis / diagnostic imaging
  • Pancreatitis / epidemiology
  • Pancreatitis / surgery*
  • Practice Guidelines as Topic*
  • Recurrence
  • Severity of Illness Index
  • Sphincterotomy, Endoscopic
  • Time Factors
  • Tomography, X-Ray Computed