MILD TO MODERATE ACUTE GALLSTONE PANCREATITIS: A COMPARATIVE STUDY OF EARLY VERSUS DELAYED CHOLECYSTECTOMY

Abstract

Background: About 75% of cases of acute pancreatitis in affluent countries are caused by gallstones. The biliopancreatic system's persistent obstructions, which cause the pancreas to gradually inflame, are the main cause of acute gallstone-induced pancreatitis. After an acute gallstone-induced pancreatitis episode, there may be recurrent pancreatitis episodes, common bile duct blockage, acute cholangitis episodes, or sporadic episodes of controllable biliary colic. Cholecystectomy is delayed until the local problems are treated, when severe pancreatitis with consequences such as pancreatic necrosis and organ failure are noted. The goal of early cholecystectomy is to reduce the risk of recurrent severe acute gallstone-induced pancreatitis, which is associated with serious health problems and an increased death rate. On the other hand, because early cholecystectomy is linked to a greater likelihood of complications and mortality, many surgeons often favour delayed cholecystectomy.

Objective: Examine the differences between patients receiving early versus delayed cholecystectomy for mild to moderate acute gallstone-induced pancreatitis (AGP) in terms of surgical duration, perioperative complications, conversion rate, length of hospital stay, and recurrence of gallstone-related disorders.

Study design: A Randomized controlled trial

Place and Duration: This study was conducted in Peoples University of Medical and Health Sciences Nawabshah from September 2022 to September 2023

Methodology: The participants of this study were aged 18 years and older. All of the patients were presented to the Department of General Surgery. All of the participants were diagnosed with mild-to-moderate AGP. Random sampling was used to place patients into two groups: early cholecystectomy (EC) and late cholecystectomy (LC). On a premade form, data on preoperative, intraoperative, and postoperative progress was gathered. Fisher's exact test was used to compare data with dichotomous variables that were reported as percentages. A P-value of less than 0.05 was seen as significant.

Results: A total of 100 patients were selected for this study because they met the inclusion criteria for this research. All of the individuals were diagnosed with acute gallstone-induced pancreatitis. The average age was 45.1 years. The age of the participants ranged from 18 to 75 years, respectively. Patients were divided into 2 groups: the EC (Early cholecystectomy) group and the DC (Delayed cholecystectomy) group, with each having 50 patients. The number of recurrent biliary events was 0 in the EC group, while it was 15 in the DC group.

Conclusion: The most effective method of treatment for AGP is a laparoscopic early cholecystectomy, which is safe and practical after the acute period.