Mild acute biliary pancreatitis: The timing of cholecystectomy should not exceed index admission

BACKGROUND: Laparoscopic cholecystectomy (LC) to treat mild biliary acute pancreatitis (MBAP) during index admission is recommended. However, the optimal surgical timing is controversial, considering that patients are actually often discharged from hospital and readmitted for elective cholecystectomy. Moreover, previous studies showed an uneven patients' stratification for pancreatitis severity. The aim of this study was to determine the outcome of patients homogenously categorizedfor MBAP according to the newest pancreatitis classifications, undergoing cholecystectomy with different timing. METHODS: We retrospectively identified all patients undergoing cholecystectomy from 2008 to 2015 for MBAP, according to the 2012 Revision of the Atlanta Classification and the Determinant-Based Classification of Acute Pancreatitis, and stratified them in two groups: index cholecystectomy (IC) and interval-delayed cholecystectomy (IDC, after at least 4 weeks). RESULTS: One hundred and three patients were analyzed. IC was performed in 40 patients (38.8%) while IDC in 63 patients (61.2%). The two groups were similar in comorbidities and pancreatitis severity at admission. There were no differences for conversion rate, operation length, total length of hospitalization and overall complication rates. However, IDC patients had a 33.3% rate of re-hospitalization for recurrent biliary-pancreatic events while waiting for the elective procedure and showed a higher rate of acute cholecystitis at histological diagnosis than IC (11.1% vs. 0%, P=0.041). CONCLUSIONS: Among patients affected by MBAP, homogenously assessed following the new acute pancreatitis severity scores, the performance of cholecystectomy during the index admission is the best treatment option in order to avoid further undesired hospitalizations for recurrent biliary/pancreatic events while waiting for surgery.