Meta-Analysis
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. May 6, 2021; 9(13): 3038-3047
Published online May 6, 2021. doi: 10.12998/wjcc.v9.i13.3038
Early vs late cholecystectomy in mild gall stone pancreatitis: An updated meta-analysis and review of literature
Saqib Walayat, Muhammad Baig, Srinivas R Puli
Saqib Walayat, Department of Internal Medicine, OSF Saint Francis Medical Center, University of Illinois Peoria Campus, Peoria, IL 61637, United States
Muhammad Baig, Department of Gastroenterology, University of Illinois, Peoria, IL 61637, United States
Srinivas R Puli, Department of Medicine, University of Illinois-Peoria, Peoria, IL 61604, United States
Author contributions: Walayat S and Baig M collected data, reviewed the literature, drafted the manuscript and approved the final version of the article to be published; Puli S analyzed the data, made critical revisions related to the content of the article and approved the final version of the article to be published.
Conflict-of-interest statement: All authors have no conflict of interest to disclose.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist. PRISMA diagram included.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Saqib Walayat, MD, Academic Fellow, Department of Internal Medicine, OSF Saint Francis Medical Center, University of Illinois Peoria Campus, 530 NE Glen Oak Ave, Peoria, IL 61637, United States. saqib.k.walayat@osfhealthcare.org
Received: December 17, 2020
Peer-review started: December 17, 2020
First decision: December 25, 2020
Revised: February 7, 2021
Accepted: March 10, 2021
Article in press: March 10, 2021
Published online: May 6, 2021
Processing time: 126 Days and 10.7 Hours
Abstract
BACKGROUND

Gallstone pancreatitis is one of the most common causes of acute pancreatitis. Cholecystectomy remains the definitive treatment of choice to prevent recurrence. The rate of early cholecystectomies during index admission remains low due to perceived increased risk of complications.

AIM

To compare outcomes including length of stay, duration of surgery, biliary complications, conversion to open cholecystectomy, intra-operative, and post-operative complications between patients who undergo cholecystectomy during index admission as compared to those who undergo cholecystectomy thereafter.

METHODS

Statistical Method: Pooled proportions were calculated using both Mantel-Haenszel method (fixed effects model) and DerSimonian Laird method (random effects model).

RESULTS

Initial search identified 163 reference articles, of which 45 were selected and reviewed. Eighteen studies (n = 2651) that met the inclusion criteria were included in this analysis. Median age of patients in the late group was 43.8 years while that in the early group was 43.6. Pooled analysis showed late laparoscopic cholecystectomy group was associated with an increased length of stay by 88.96 h (95%CI: 86.31 to 91.62) as compared to early cholecystectomy group. Pooled risk difference for biliary complications was higher by 10.76% (95%CI: 8.51 to 13.01) in the late cholecystectomy group as compared to the early cholecystectomy group. Pooled analysis showed no risk difference in intraoperative complications [risk difference: 0.41%, (95%CI: -1.58 to 0.75)], postoperative complications [risk difference: 0.60%, (95%CI: -2.21 to 1.00)], or conversion to open cholecystectomy [risk difference: 1.42%, (95%CI: -0.35 to 3.21)] between early and late cholecystectomy groups. Pooled analysis showed the duration of surgery to be prolonged by 39.11 min (95%CI: 37.44 to 40.77) in the late cholecystectomy group as compared to the early group.

CONCLUSION

In patients with mild gallstone pancreatitis early cholecystectomy leads to shorter hospital stay, shorter duration of surgery, while decreasing the risk of biliary complications. Rate of intraoperative, post-operative complications and chances of conversion to open cholecystectomy do not significantly differ whether cholecystectomy was performed early or late.

Keywords: Cholecystectomy; Gallstone pancreatitis; Acute pancreatitis; Laparoscopic cholecystectomy; Biliary colic; Open cholecystectomy

Core Tip: Despite recommendations from International societies rate of early cholecystectomy post gallstone pancreatitis remains low, presumably due to perceived increased risks of complications. Our updated meta-analysis shows early cholecystectomy leads to decreased risk of biliary complications in patients with mild gallstone pancreatitis. It also leads to shorter hospital stay and shorter duration of surgery. Our data did not show any difference between the rate of intraoperative or postoperative complications between the two groups.