COMPARISION BETWEEN EARLY AND DELAYED CHOLECYSTECTOMY IN ACUTE BILIARY PANCREATITIS

Abstract

Background: Acute biliary pancreatitis is a common surgical emergency requiring inpatient conservative management. Cholecystectomy is critical in preventing recurrent episodes and minimizing additional biliary complications. However, the optimal timing for cholecystectomy remains a matter of ongoing debate. Early laparoscopic cholecystectomy has been suggested to improve outcomes, but further evidence is required to validate its benefits compared to delayed surgery in patients with mild to moderate acute biliary pancreatitis.

Objective: This study aimed to compare the outcomes of early versus delayed laparoscopic cholecystectomy for acute biliary pancreatitis in a tertiary care hospital setting.

Methods: A randomized controlled trial was conducted in the General Surgery Department of Fauji Foundation Hospital, Rawalpindi, from July 2024 to December 2024. A total of 100 patients, aged 20–60 years, with mild to moderate acute biliary pancreatitis (ASA grades I or II), were enrolled and randomized into two groups. Group A (early cholecystectomy) underwent surgery within 7 days of symptom onset, whereas Group B (delayed cholecystectomy) underwent surgery between 8 days and 6 weeks after symptom onset. Cholecystectomy was performed following a standardized laparoscopic technique. Data were analyzed using SPSS version 17, with Chi-square tests applied to compare outcomes such as intraoperative bleeding, postoperative fever, severe abdominal pain, and atelectasis. A p-value ≤0.05 was considered statistically significant.

Results: The mean age of patients in the early cholecystectomy group was 43.94 ± 11.26 years, while it was 46.38 ± 9.23 years in the delayed group. Females predominated in both groups (72% in early and 70% in delayed groups). Intraoperative bleeding occurred in 20% of early cholecystectomy patients compared to 34% in the delayed group (p=0.115). Postoperative severe abdominal pain was significantly lower in the early group (18% vs. 36%; p=0.043), as was postoperative fever (22% vs. 48%; p=0.006). Atelectasis occurred in 12% of early group patients and 22% of delayed group patients, with a statistically significant difference between the groups (p=0.183).

Conclusion: Early laparoscopic cholecystectomy significantly reduces postoperative complications such as severe abdominal pain and fever in patients with acute biliary pancreatitis. The findings particularly highlight the benefits for patients with elevated BMI and advanced age, advocating for individualized treatment strategies. Future studies with larger sample sizes and longer follow-up periods are recommended to confirm these results and optimize management protocols.