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
ARTICLE HIGHLIGHTS
Research background

Gall stone pancreatitis is one of the most common causes of acute pancreatitis (30%-50%). Cholecystectomy remains the definitive treatment of choice for gallstone pancreatitis.

Research motivation

While, most of the major societies recommend early cholecystectomy for mild gallstone pancreatitis, the rate of early cholecystectomy during index admission remains low due to perceived increased risk of complications.

Research objectives

The aim of our updated meta-analysis was to compare the length of stay, duration of surgery, biliary complications, conversion to open cholecystectomy, intra-operative, and post-operative complications between patients who underwent early cholecystectomy vs those who underwent late cholecystectomy.

Research methods

Study Selection Criteria: Prospective, retrospective and randomized controlled trials comparing outcomes of early (surgery within the 2 wk of pancreatitis ) vs late cholecystectomy in patients with mild gallstone pancreatitis were included in this analysis. Pooled proportions were calculated using both Mantel-Haenszel method (fixed effects model) and DerSimonian Laird method (random effects model). The heterogeneity among studies was tested using Cochran’s Q test based upon inverse variance weights.

Research results

Eighteen studies (n = 2651) were included in this analysis. Late laparoscopic cholecystectomy was associated with an increased length of stay by 88 h comparted to early group (95%CI: 86.3 to 91.6). Late group also had an increased duration of surgery by 39 min compared to early group (95%CI: 37.4 to 40.7). Risk of biliary complications was 10.76 % higher in late cholecystectomy group as compared to later group (95%CI: 8.51 to 13.01). The chances of conversion to open cholecystectomy was 1.42 % higher in the delayed surgery.

Research conclusions

In conclusion, early cholecystectomy appears to be not only safe but also may be associated with shorter length of stay and duration of surgery as compared to late cholecystectomy. The rate of complications also appear to higher in patients who undergo late cholecystectomy with higher chances of conversion to open cholecyste-ctomy.

Research perspectives

The definition of early cholecystectomy remains variable in different studies, moreover there is paucity of studies with elderly population which are at higher risk of complications. Future studies should be more focused to determine optimal timing of surgery after an attack of acute pancreatitis, also outcomes of early cholecystecotmy in elderly populations need to be further studied.