Early laparoscopic cholecystectomy in acute mild gallstone pancreatitis. Is there a role for routine admission contrast-enhanced CT Scan?
Acute gallstone pancreatitis
Early laparoscopic cholecystectomy
Enhanced-CT Scan
Journal
Langenbeck's archives of surgery
ISSN: 1435-2451
Titre abrégé: Langenbecks Arch Surg
Pays: Germany
ID NLM: 9808285
Informations de publication
Date de publication:
18 Jul 2024
18 Jul 2024
Historique:
received:
19
01
2024
accepted:
26
06
2024
medline:
18
7
2024
pubmed:
18
7
2024
entrez:
18
7
2024
Statut:
epublish
Résumé
This study aims to evaluate the efficacy of admission contrast-enhanced CT scans in formulating strategies for performing early laparoscopic cholecystectomy in cases of acute gallstone pancreatitis. Patients diagnosed with acute gallstone pancreatitis underwent a CT scan upon admission (after at least 24 h from symptom onset) to confirm diagnosis and assess peripancreatic fluid, collections, gallstones, and common bile duct stones. Patients with mild acute gallstone pancreatitis, following the Atlanta classification and Baltazar score A or B, were identified as candidates for early cholecystectomy (within 72 h of admission). Within the analyzed period, 272 patients were diagnosed with mild acute gallstone pancreatitis according to the Atlanta Guidelines. A total of 33 patients (12.1%) were excluded: 17 (6.25%) due to SIRS, 10 (3.6%) due to local complications identified in CT (Balthazar D/E), and 6 (2.2%) due to severe comorbidities. Enhanced CT scans accurately detected gallstones, common bile duct stones, pancreatic enlargement, inflammation, pancreatic collections, and peripancreatic fluid. Among the cohort, 239 patients were selected for early laparoscopic cholecystectomy. Routine intraoperative cholangiogram was conducted in all cases, and where choledocholithiasis was present, successful treatment occurred through common bile duct exploration. Only one case required conversion from laparoscopic to open surgery. There were no observed severe complications or mortality. Admission CT scans are instrumental in identifying clinically stable patients with local tomographic complications that contraindicate early surgery. Patients meeting the criteria for mild acute gallstone pancreatitis, as per Atlanta guidelines, without SIRS or local complications (Baltazar D/E), can safely undergo early cholecystectomy within the initial 72 h of admission.
Identifiants
pubmed: 39023574
doi: 10.1007/s00423-024-03394-w
pii: 10.1007/s00423-024-03394-w
doi:
Substances chimiques
Contrast Media
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
219Informations de copyright
© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
Références
Moody N, Adiamah A, Yanni F, Gomez D (2019) Meta-analysis of randomized clinical trials of early versus delayed cholecystectomy for mild gallstone pancreatitis. Br J Surg 106:1442–51. https://doi.org/10.1002/bjs.11221
doi: 10.1002/bjs.11221
pubmed: 31268184
Lankisch PG, Breuer N, Bruns A, Weber-Dany B, Lowenfels AB, Maisonneuve P (2009) Natural history of acute pancreatitis: a long-term population-based study. Am J Gastroenterol 104:2797–805. https://doi.org/10.1038/ajg.2009.405
doi: 10.1038/ajg.2009.405
pubmed: 19603011
Group DPS, Dutch Pancreatitis Study Group, Bakker OJ, van Santvoort HC, Hagenaars JC, Besselink MG et al (2011) Timing of cholecystectomy after mild biliary pancreatitis. Br J Surg 98:1446–54. https://doi.org/10.1002/bjs.7587
doi: 10.1002/bjs.7587
Aboulian A, Chan T, Yaghoubian A, Kaji AH, Putnam B, Neville A et al (2010) Early cholecystectomy safely decreases hospital stay in patients with mild gallstone pancreatitis. Ann Surg 251:615–9. https://doi.org/10.1097/sla.0b013e3181c38f1f
doi: 10.1097/sla.0b013e3181c38f1f
pubmed: 20101174
El-Dhuwaib Y, Deakin M, David GG, Durkin D, Corless DJ, Slavin JP (2012) Definitive management of gallstone pancreatitis in England. Ann R Coll Surg Eng. 94:402–6. https://doi.org/10.1308/003588412x13171221591934
doi: 10.1308/003588412x13171221591934
Giuffrida P, Biagiola D, Cristiano A, Ardiles V, de Santibañes M, Sanchez Clariá R et al (2020) Laparoscopic cholecystectomy in acute mild gallstone pancreatitis: how early is safe? Updates Surg 72(1):129–135
doi: 10.1007/s13304-020-00714-9
pubmed: 32009229
Banks PA, Bollen TL, Dervenis C, Gooszen HG, Johnson CD, Sarr MG et al (2013) Classification of acute pancreatitis–2012: revision of the Atlanta classification and definitions by international consensus. Gut 62(1):102–111
doi: 10.1136/gutjnl-2012-302779
pubmed: 23100216
Dindo D. The Clavien–Dindo Classification of Surgical Complications. Treatment of Postoperative Complications After Digestive Surgery. 2014. p. 13–7. https://doi.org/10.1007/978-1-4471-4354-3_3
Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD et al (2009) The Clavien-Dindo Classification of Surgical Complications. Ann Surg 250:187–96. https://doi.org/10.1097/sla.0b013e3181b13ca2
doi: 10.1097/sla.0b013e3181b13ca2
pubmed: 19638912
Pellegrini CA (1993) Surgery for gallstone pancreatitis. Am J Surg 165:515–8. https://doi.org/10.1016/s0002-9610(05)80952-3
doi: 10.1016/s0002-9610(05)80952-3
pubmed: 8480893
Kelly TR, Elliott DW (1990) Proper timing of surgery for gallstone pancreatitis. Am J Surg 159:361–2. https://doi.org/10.1016/s0002-9610(05)81270-x
doi: 10.1016/s0002-9610(05)81270-x
pubmed: 2316797
Dubina ED, de Virgilio C, Simms ER, Kim DY, Moazzez A (2018) Association of early vs delayed cholecystectomy for mild gallstone pancreatitis with perioperative outcomes. JAMA Surg 153:1057. https://doi.org/10.1001/jamasurg.2018.2614
doi: 10.1001/jamasurg.2018.2614
pubmed: 30140844
pmcid: 6583064
Di Martino M, Ielpo B, Pata F et al (2023) Timing of cholecystectomy after moderate and severe acute biliary pancreatitis. JAMA Surg 158(10):e233660. https://doi.org/10.1001/jamasurg.2023.3660
doi: 10.1001/jamasurg.2023.3660
pubmed: 37610760
Pancreatitis UKWP on A, UK Working Party on Acute Pancreatitis (2005) UK guidelines for the management of acute pancreatitis. Gut 549:iii1-9. https://doi.org/10.1136/gut.2004.057026
doi: 10.1136/gut.2004.057026
Uhl W, Warshaw A, Imrie C, Bassi C, McKay CJ, Lankisch PG et al (2002) IAP Guidelines for the surgical management of acute pancreatitis. Pancreatology 2:565–73. https://doi.org/10.1159/000067684
doi: 10.1159/000067684
pubmed: 12435871
International association of pancreatology. https://internationalpancreatology.org/ . Accessed 18 June 2024
American Gastroenterological Association. https://gastro.org/ . Accessed 18 June 2024
UK guidelines for the management of acute pancreatitis Gut (2005) 54:iii1-iii9. https://gut.bmj.com/content/54/suppl_3/iii1 . Accessed 18 June 2024
Podda M, Pellino G, Coccolini F et al (2021) Compliance with evidence-based clinical guidelines in the management of acute biliary pancreatitis: the MANCTRA-1 study protocol. Updates Surg 73:1757–1765. https://doi.org/10.1007/s13304-021-01118-z
doi: 10.1007/s13304-021-01118-z
pubmed: 34142315
pmcid: 8211303
Raghuwanshi S, Gupta R, Vyas MM, Sharma R (2016) CT Evaluation of Acute Pancreatitis and its Prognostic Correlation with CT Severity Index. J Clin Diagn Res 10(6):TC06-11
pubmed: 27504376
pmcid: 4963736