Optimal timing of cholecystectomy after necrotising biliary pancreatitis crucial: Study

While, the secondary outcomes were the number of recurrent biliary events, periprocedural complications of cholecystectomy and the protective value of endoscopic sphincterotomy for the recurrence of biliary events.

Overall, 248 patients were included in the analysis. Cholecystectomy was performed in 191 patients (77%) at a median of 103 days (P25–P75: 46–222) after discharge.

The following findings were established –

1. Infected necrosis after cholecystectomy occurred in four (2%) patients with persistent peripancreatic collections.
2. Before cholecystectomy, 66 patients (27%) developed biliary events.
3. The risk of overall recurrent biliary events prior to cholecystectomy was significantly lower before 10 weeks after discharge (risk ratio 0.49 (95% CI 0.27 to 0.90); p=0.02).
4. The risk of recurrent pancreatitis before cholecystectomy was significantly lower before 8 weeks after discharge (risk ratio 0.14 (95% CI 0.02 to 1.0); p=0.02).
5. The complication rate of cholecystectomy did not decrease over time.
6. Endoscopic sphincterotomy did not reduce the risk of recurrent biliary events.

Hence, the optimal timing of cholecystectomy after necrotising biliary pancreatitis, in the absence of peripancreatic collections, is within 8 weeks after discharge, the authors concluded.

http://dx.doi.org/10.1136/gutjnl-2021-324239