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Original article  145

Laparoscopic cholecystectomy role in the management of

acute biliary pancreatitis
Mohammed L. Alameldeena, Galal M. Abouelnagahb, Tarek M. Rageha,
Mohammed O. Ammarc
a
Department of General Surgery, Faculty
of Medicine, Menofia University, Menofia,
b
Department of General Surgery, Faculty of
Medicine, Alexandria University, Alexandria,
c
Department of General Surgery, Naser
Institute, Cairo, Egypt
Correspondence to Mohammed O. Ammar,
MBBCH,
Sedi Bishr, Alexandria, Egypt
Postal code: 21519
Tel: +20 112 220 2211
e‑mail: mail: dramar2011@yahoo.com
Received 6 November 2016
Accepted 29 January 2017
Menoufia Medical Journal 2018, 31:145–151
Objective
The aim of this paper was to evaluate the role of laparoscopic cholecystectomy (LC) in the
management of acute biliary pancreatitis before patient discharge from the point of view of
availability, advantages, and disadvantages.
Background
In patients with mild gallstone pancreatitis, cholecystectomy during the same hospital
admission might reduce the risk of recurrent gallstone‑related complications, compared with
the more commonly used strategy of interval cholecystectomy. However, evidence to support
same‑admission cholecystectomy is poor, and concerns exist about an increased risk of
cholecystectomy‑related complications with this approach. In this study, we aimed to compare
same‑admission and interval cholecystectomy, with the hypothesis that same‑admission
cholecystectomy would reduce the risk of recurrent gallstone‑related complications without
increasing the difficulty of surgery.
Patients and methods
This is a prospective study carried on 20 consecutive patients in Menoufia University, Faculty of
Medicine and Alexandria University, Faculty of Medicine; all of them presented with symptoms
of acute biliary pancreatitis from April 2015 to September 2016. Overall, 20 cases were included
because of limited number of patient who presented to our hospital in this period of time and
fulfilled the inclusion criteria. Computed tomography severity index is the main  method for
choosing patients in the study then assess operative time and difficulty and postoperative
pain and hospital stay and recurrence of attacks.
Results
A total of 20 cases underwent LC at the same time of admission in the hospital, and none of
them (0%) were converted to open technique; operative time and difficulty was average, and
all of them (100%) had  no recurrent attacks of pancreatitis in postoperative follow‑up.
Conclusion
LC in mild acute biliary pancreatitis is safe and should be done during the same hospital
admission to prevent further attacks of pancreatitis.

Keywords:
biliary pancreatitis, cholecystectomy-related complications, laparoscopic cholecystectomy

Menoufia Med J 31:145–151

© 2018 Faculty of Medicine, Menoufia University
1110‑2098

Doing laparoscopic cholecystectomy  (LC) within

Introduction
2  weeks of the index admission to prevent biliary
Acute biliary pancreatitis is a common condition
pancreatitis recurrence and shorten overall hospital
throughout the world, marked by pancreatic
inflammation caused by gallstones. Although initial stay has been recommended, as early cholecystectomy
treatment of biliary pancreatitis is supportive, definitive is beneficial compared with delayed surgery [1,6–8].
treatment of biliary pancreatitis to prevent recurrence
LC is the gold standard operation for
requires cholecystectomy to remove the source of
cholecystectomy  [9], and several studies have also
gallstones. Without definitive treatment, the recurrence
found that LC is a safe and efficient treatment
rate of biliary pancreatitis is as high as 60% [1–3].
approach for acute biliary pancreatitis compared with
Historically, cholecystectomy for biliary pancreatitis open cholecystectomy [10,11].
has often been delayed from index hospitalization
to allow the patient to recover from physiologic
This is an open access journal, and articles are distributed under the terms
insult of the inciting pancreatitis  [4,5]. However, in
of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0
the last decade, the standard of care for the timing License, which allows others to remix, tweak, and build upon the work non-
of cholecystectomy now trends toward earlier commercially, as long as appropriate credit is given and the new creations
intervention. are licensed under the identical terms.

1110-2098 © 2018 Faculty of Medicine, Menoufia University DOI: 10.4103/mmj.mmj_600_16

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146  Menoufia Medical Journal, Volume 31 | Number 1 | January‑March 2018
Decreased length of hospital stay   could  be achieved
safely with LC for mild biliary pancreatitis, even with
elevated serum pancreatic enzymes and persistent
abdominal pain, with no increase in intraoperative
complications or technical difficulty [12].
Early LC for biliary pancreatitis decreases cost for
the patient by decreasing the need for long hospital
stay, ICU admission, and endoscopic retrograde
cholangiopancreatography if recurrent attacks of
biliary pancreatitis with increased risk for obstructive
jaundice to occur; moreover, it is feasible and easy,
and decreases the rate of biliary system injury during
surgery. Preventing recurrent attacks of biliary
pancreatitis avoids high risk of multiple organ failure
during attacks of pancreatitis [13].
The aim of the work was to evaluate the role of LC
in the management of acute biliary pancreatitis before
patient discharge from the point of view of availability,
advantages, and disadvantages.
Patients and methods
All patients gave written informed consent before
inclusion into the study. This is a follow‑up study
carried on 20 consecutive patients in Menoufia
University, Faculty of Medicine and Alexandria
University, Faculty of Medicine; all of them presented
with symptoms of acute biliary pancreatitis from April
2015 to September 2016.
A written informed consent from each patient
was obtained before study participation and after
full explanation of the technique and its possible
complications. The study was approved by our Faculty
Ethical Committee.
Inclusion criteria
The inclusion criteria were patients with chronic
calculous cholecystitis associated with acute pancreatitis,
demonstrated by elevated serum levels of amylase and
lipase, ultrasonographic findings of pancreatitis, and
computed tomography severity index (CTSI) of mild
pancreatitis.
Exclusion criteria
The exclusion criteria were pancreatic pseudocyst,
pancreatic abscess, pancreatic fistula, past history of
previous upper abdominal operation which should
exclude laparoscopy, coagulation disorders, CTSI more
than 5 (severe pancreatitis), and unfit for laparoscopic
surgery  (glaucoma, pulmonary emphysema, or heart
failure).
All patients were subjected to the following: thorough
history taking and physical examination. The following
groups underwent further investigations: patients who
complained of manifestations of chronic calculous
cholecystitis (fatty dyspepsia and biliary colics) with a
recent history of obstructive jaundice and patients with
manifestations of pancreatitis as epigastric pain referred
to the back associated with nausea and vomiting.
These patients were subjected to the following
investigations: laboratory investigations included
serum bilirubin (total and direct), alkaline
phosphatase  (ALP), alanine aminotransferase  (ALT),
aspartate aminotransferase  (AST), serum amylase,
serum lipase, and white blood cell (WBC) count.
Imaging included abdominal ultrasonography, which
shows gallbladder stones, intrahepatic bile duct, and
bulky pancreas, and if there is dilated common bile
duct (CBD) by ultrasound or elevated ALP enzyme, the
patients were subjected to further magnetic resonance
cholangiopancreatography (MRCP) to verify the cause
of obstructive jaundice.
CT of the abdomen shows gallstones, CBD diameter,
bulky pancreas, peripancreatic fluid collection, or
complications such as necrosis or pseudocyst. Research
has shown some advantages of the CTSI in predicting
the severity of acute pancreatitis compared with the
other systems.
Computed tomography severity index score
CTSI of 5 or greater correlated with prolonged
hospitalization and higher rates of mortality and
morbidity.
A CTSI score of 5 or greater was associated with a
mortality rate higher than in those with a score of less
than 5.
The numerical CTSI has a maximum of 10 points and
is the sum of the Balthazar grade points and pancreatic
necrosis grade points.
If the patient is evaluated as a mild case of acute
pancreatitis (CTSI score less than 5), we will proceed
to LC within 72 h from assessment.
Balthazar grade points
Grade  A is considered   when  the patient’s computed
tomography  (CT) result of the abdomen is normal,
and this equals 0 point. Grade  B is considered when
there is focal or diffuse enlargement of the pancreas,
and this equals 1 point. Grade  C is considered
when there is pancreatic gland abnormalities and
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Laparoscopic cholecystectomy in pancreatitis Alameldeen et al.  147
peripancreatic inflammation, and this equals 2 points.
Grade D is considered when there is fluid collection in
a single location, and this equals 3 points. Grade E is
considered when there is two or more fluid collections
and/or gas bubbles in or adjacent to pancreas, and this
equals 4 points.
Necrosis grade points
When there is no necrosis, it equals 0 points. If the
necrosis percent is 0–30%, it equals 2 points. If the
necrosis percent is 30–50%, it equals 4 points, and
if the necrosis percent is more than 50%, it equals
to 6 points.
Operative technique
LC was done for all patients subjected to the study,
and intraoperative assessment is done according to
time, difficulty, and conversion to open surgery when
required. Conversion to open procedure was performed
through a right subcostal incision.
Laparoscope  used was the Karl Storz Endoscope
set, telecam DX II, Hopkins II optics, code
no. 26003 BA, Karl Storz SE & Co. KG, Germany.
The protocol of general anesthesia was uniform in all
patients; isoflurane 1–2% was used for maintenance.
Prophylactic antibiotics were given at the time of
induction of anesthesia, usually third‑generation
cephalosporins.
Position of the patient was supine on an radiography
operation table.
Laparoscopic instruments were placed on a separate
stand located on the patient’s left. This arrangement
allowed efficient surgeon access to the instruments
with the least chaos.
All operating room personnel were appropriately
protected with lead aprons to minimize their exposure
to radiation if intraoperative cholangiogram is planned
to exclude CBD stones.
Insertion of a suitable size nasogastric tube was done to
deflate the stomach.
Laparoscopic ports were placed in the standard
approach used in LC. A  four‑port technique as
described by Reddick and Olsen [14] was employed
with a zero degree laparoscope. A supraumblical port of
5–12 mm was inserted by the closed method. Another
5–12  mm epigastric and two 5  mm right subcostal
ports were inserted under direct vision.
We preferred the use of disposable Endopath Bladeless
XCEL trocars (5–12 mm) with transparent obturator
for optical 
  entry  (B12LT; Ethicon Endosurgery,
Guaynabo, PR 00969, United States).
Exploration of the abdomen was done. The gallbladder
is grasped from its fundus.
If necessary, the gallbladder is emptied through
aspiration to help better grasping. Traction on the
Hartmann’s pouch was performed to expose the cystic
duct. Identification of Calot’s triangle was done.
Dissection of the cystic duct and cystic artery was done
separately, and both are clipped and divided.
The gallbladder will be dissected off its bed with a
monopolar cautery hook.
At the completion of the surgery, the gallbladder will
be placed in a retrieval bag and extracted through the
epigastric incision.
Hemostasis was achieved in the gallbladder bed, and
after through saline lavage, a tube drain was placed if
clinically indicated, and the incisions closed.
Postoperative management
Postoperative analgesia was carried out with ketorolac
during the first 24 h postoperatively and thereafter at
the request of the patient.
Patients were observed for sepsis, bleeding, pancreatitis,
and bile leak. These complications could occur usually
within the first 24 h postoperatively.
Routine postoperative laboratory tests included serum
amylase, serum lipase, and WBC count.
All patients had warm oral liquids in the evening after
the operation, provided there was no nausea or vomiting.
Most patients were discharged from the hospital
after 24  h. Patients were reviewed at weeks 1 and 4
postoperatively in the surgical outpatient clinic.
Patients were instructed to notify after discharge about
any clinical symptoms or any laboratory or imaging
data that they had obtained because of the possibility
of a postoperative biliary disease.
Postoperative assessment
It included assessment of pain, total length of hospital stay,
need for ICU admission and total stay in ICU, recurrence
of attacks of biliary pancreatitis, organ failure, biliary
leakage, incidence of attacks of cholangitis, and cost.
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148  Menoufia Medical Journal, Volume 31 | Number 1 | January‑March 2018

Follow‑up of the cases variables were elevated. The mean value for ALP was
Complications were defined as any intraoperative or 189.5 ± 111.92 U/l (range: 79–445 U/l), total bilirubin
postoperative (30 days after the operation) events that was 2.33 ± 1.97 mg/dl (range: 0.6–6.3 mg/dl), direct
altered the clinical course such as complications of bilirubin was 1.46 ± 1.79 mg/dl (range: 0.1–5.9 mg/dl),
LC (bile duct lesions, bleeding, abdominal collection), AST was 209.7 ± 252.41 U/l (range: 27–914 U/l), ALT
pneumonia, additional procedures, and readmissions. was 118.1 ± 175.25 U/l (range: 17–580 U/l), WBC count
was11.21 + 4.48 cells/cm3(range:4.1–18.9 cells/cm3),serum
Later on, patients were followed up in the outpatient amylase was 790.4 + 897.5 U/l (range: 47–2933 U/l),
clinic on monthly intervals for 3 months; liver function and serum lipase was 1059.5  +  1629.46 U/l (range:
tests and ultrasonography of the abdomen were 52–5182 U/l). ALP was elevated in 14 (70%) cases.
performed to exclude missed stones or other long‑term Total bilirubin was elevated in 12  (60%) cases, and
complications. levels higher than 4  mg were found in eight  (40%)
cases. Direct bilirubin was elevated in 10  (50%)
Follow‑up was done by clinical observation of cases. AST was elevated in 14 (70%) cases, ALT in
abdominal pain, the color of sclera, asking about the eight  (40%) cases, WBC count in 14  (70%) cases,
color of the urine and stool, serum bilirubin (total and serum amylase in 18 (90%) cases, and serum lipase in
direct), ALP, amylase, and lipase, ultrasonography of 16 (80%) cases (Table 2).
the abdomen (after 1  month). MRCP if indicated
(suspicion of the presence of retained stones). At initial presentation, all cases  (20  cases, 100%)
complained of pain  (epigastric pain referred to the
back). Pain was characterized most frequently as severe
pain and described as knifing to the back. It precedes
Results the onset of nausea and vomiting, and vomiting does
A total of 20  patients were included; there were not relieve the pain (Table 3).
14 (70%) women and six (30%) men, with mean ± SD
age of 42  ±  16.26  years, median age of 39  years, and Obstructive jaundice was present in 12  (60%) cases
range of 22–75 years (Table 1). at the time of presentation. In contrast, absence of
any history of jaundice was claimed by eight  (40%)
The most important eight laboratory investigations patients. Two  (10%) cases had a positive history of
that were observed in our patients were as follows: cholangitis  (i.e.,  pain, fever and chills, jaundice and
ALT, AST, ALP, total bilirubin, direct bilirubin, WBC leukocytosis), and two  (10%) cases presented with
count, serum amylase, and lipase. Table 2 illustrates the a history of previous attack of gallstone pancreatitis
number of abnormal findings of these eight variables documented by previous high serum amylase and lipase
among our patients. In two (10%) patients, all the eight levels and positive findings on ultrasonography and
CT of the abdomen. Duration of symptoms before the
Table 1 Distribution of the studied cases according to
demographic data procedure varied as follows: the mean ± SD duration
Variables n (%) of symptoms before diagnosis was 8.5  +  8.61  days,
Sex median was 5.5  days, and ranged from 2 to 30  days
Male 6 (30.0) (Table 3).
Female 14 (70.0)
Age The second is the CTSI: it is calculated by adding the
Range 22.0‑75.0 Balthazar score to the percentage of pancreatic necrosis.
Mean±SD 42.0±16.26 Most cases are equal or below 4, which are considered
Median 39.0 as mild pancreatitis. Score 1 in two (10%) cases, score
Table 2 Description of the studied cases according to preoperative laboratory investigations
Range Mean±SD Median Normal range
ALT (SGOT) 17.0‑580.0 118.10±175.25 29.0 0‑45 U/l
AST (SGPT) 27.0‑914.0 209.70±252.41 156.50 0‑40 U/l
Total bilirubin 0.60‑6.30 2.33±1.97 1.50 0‑1.2 mg/dl
Direct bilirubin 0.10‑5.90 1.46±1.79 0.70 0‑0.4 mg/dl
ALP 79.0‑445.0 189.50±111.92 148.0 0‑137 mg/dl
WBC 4.10‑18.90 11.21±4.48 11.95 4000‑11 000
PA 80.0‑99.0 91.10±5.59 91.50 More than 70%
Amylase 47.0‑2933.0 790.40±897.50 378.0 22‑100 U/l
Lipase 52.0‑5182.0 1095.50±1629.46 221.50 0‑60 U/l
ALT, alanine aminotransferase; ALP, alkaline phosphatase; AST, aspartate aminotransferase; SGOT, serum glutamic oxaloacetic
transaminase; SGPT, serum glutamic pyruvic transaminase; WBC, white blood cells; PA, prothrombin activity.
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Laparoscopic cholecystectomy in pancreatitis Alameldeen et al.  149

2 in six (30%) cases, score 3 in four (20%) cases, and

Discussion
score 4 in six (30%) cases. Only two cases had score of
In our study, the mean age of patients was
5  (10%), in which pancreatic necrosis was present in
42  ±  16.26  years. In the study by Rosing et  al.  [15],
percentage ranging from 30 to 50% (Table 4).
the mean age was close to our patients of 40  years
(range: 28–54 years). In the study by Judkins et al. [16],
MRCP was done in four  (20%) cases only and
the mean age was 38.2 + 16.0 years (range: 20–80 years),
revealed multiple small gallstones in these four
and in the study by Nebiker et al. [17], the median age
cases, with only minimal intrahepatic biliary radical
was 60  years  (range: 29–83  years), which was older
dilatation in two (10%) cases. The CBD was free in
than our study. Nguyen et al. [18] reported mean age
these four cases, with diameter ranging from 7 to
of 59.6 + 20.2 years. The reason that the mean age in
9.5 mm, and mean ± SD diameter of 8.25 ± 1.44 mm
our study was younger than most similar studies is that
(Table 5).
we select our cases to be generally fit for anesthesia and
All cases are managed during the same hospital laparoscopy. However, 30% of our patients were older
than 50 years.
stay with LC; all cases were done laparoscopically,
and no conversion to open surgery was needed in
In our study, regarding female to male ratio, among the
any case. The mean duration of LC was 53  +  12.61. 20 cases, 14 (70%) cases were females, and six (30%)
From   insertion  of Veruss needle till the end of the patients were males; this was expected as the incidence
operation, the median time was 52.5  min, ranging of gallstones and biliary pancreatitis is higher in
30–75 min (Table 6). females than in males. This is in accordance with most
similar studies: Nguyen et al. [18] – 63% females and
In the present study, the mean hospital stay was
37% males, Nebiker et al. [17] – 66% females and 34%
1.8 ± 1.2 days (range: 1–4 days). A total of 18 (90%)
males, Judkins et al. [16] – 78% females and 22% males,
patients experienced mild pain, which relieved
and also Ito et al. [19] – 67% females and 33% males.
completely with the intake of two intravenous injections
of NSAID   followed  by oral intake of NSAIDs, as if In our study, the mean duration of symptoms before
LC for chronic calculous cholecystitis was done. In hospital admission was 8.50  ±  8.61  days, average of
two  (10%) cases, the pain was moderate, and only 2–30  days and median of 5.5  days; in the study by
partially improved with NSAIDs. Postoperative Rosing et  al.  [15], the duration of symptoms before
discharge for cases in our study was on postoperative diagnosis was short and less than 48 h, which reflects
day 1 in 12  cases, postoperative day 2 in four cases,
and postoperative day 3 in four cases. There were no Table 5 Distribution of the studied cases according to
mortalities (Table 7). magnetic resonance cholangiopancreatography findings
n (%)
Table 3 Distribution of the studied cases according to GB stone
presentation Single 0 (0.0)
Variables n (%) Multiple 4 (20.0)
Pain 20 (100.0) Size
Jaundice 12 (60.0) Large 0 (0.0)
History of jaundice 0 (0.0) Small 4 (20.0)
Cholangitis 2 (10.0) IHBRD
No jaundice 8 (40.0) No dilatation 2 (10.0)
History of pancreatitis 2 (10.0) Minimal 2 (10.0)
Duration (days) CBD diameter
Range 2.0‑30.0 Minimum‑maximum 7.0‑9.50
Mean±SD 8.50±8.61 Mean±SD 8.25±1.44
Median 5.50 CBD stones 0 (0.0)
Other 0 (0.0)
Table 4 Distribution of the studied cases according to CBD, common bile duct; GB, gallbladder; IHBRD, intrahepatic biliary
computed tomography severity index radical dilatation.
CTSI n (%)
1 2 (10.0) Table 6 Distribution of the studied cases according to surgery
2 6 (30.0) Variables n (%)
3 4 (20.0) Conversion to open 0 (0)
4 6 (30.0) Operative time
5 2 (0.0) Range 30‑75 min
CTSI, computed tomography severity index. Mean±SD 53±12.61
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150  Menoufia Medical Journal, Volume 31 | Number 1 | January‑March 2018
Table 7 Distribution of the studied cases according to
hospital stay
Variables n (%)
Postoperative hospital stay (days)
1 12 (60.0)
2 4 (20.0)
3 0 (0.0)
4 4 (20.0)
Range 1.0‑4.0
Mean±SD 1.80±1.20
Postoperative pain
Mild 18 (90.0)
Moderate 2 (10.0)
Severe 0 (0.0)
Peristalsis audible and oral intake
Same day 18 (90.0)
Day 1 2 (10.0)
Drain removal (days)
1 12 (60.0)
2 4 (20.0)
3 4 (20.0)
Range 1.0‑3.0
Mean±SD 1.60±0.82
that our patients were presented late, sought medical
advice late, or were misdiagnosed.
In our study, the most important laboratory
investigations that were observed were ALT, AST,
ALP, total bilirubin, direct bilirubin, WBC count,
serum amylase, and lipase. In two  (10%) patients, all
the eight variables were elevated; in six  (30%) cases,
seven variables were elevated; in two (10%) cases, six
variables were elevated; in six (30%) cases, four variables
are elevated; and in four (20%) cases, only two variables
were elevated.
Our study depends on CTSI, whereas other studies
depend on Ranson’s score below or equal to 3 to
diagnose cases of mild biliary pancreatitis; however,
in our study, it was difficult to depend on Ranson’s
score because it takes 48  h for full assessment and
delayed presentation of our patients. In the study by
Nebiker et al. [17], the diagnosis was based on history,
three‑fold increase in serum amylase activity, and
radiological investigations.
In our study, 12  (60%) patients had jaundice, so the
presence of CBD stones must be excluded. Results of
several studies [20,21] indicated that the most accurate
predictors of CBDS were serum bilirubin level (positive
predictive value of 57%, negative predictive value of
66%), serum ALP level  (positive predictive value of
53%, negative predictive value of 65%), and dilated
CBD  (positive predictive value, negative predictive
value 64%). A combination of these factors yielded a
sensitivity of 68% and a specificity of 80% and could
determine the subsequent procedure to be used.
In our study, the CBD was dilated in eight  (40%)
cases, without visualization of CBD stones by
ultrasonography, and was dilated on six (30%) cases by
CT scan, so further evaluation of the CBD was required
by either MRCP or intraoperative cholangiography.
Studies by Majeed and colleagues [22,23] have shown
a dilated CBD on ultrasonography to be predictive
in 20–70% of cases with choledocholithiasis, whereas
evidence of stones in a dilated duct at ultrasonography
was almost uniformly accurate.
In our study, MRCP was done in four  (20%) cases,
which revealed calcular gallbladder disease, with
minimal intrahepatic biliary radical dilatation in
two  (10%) cases, and no CBD stones were present
in any case. MRCP is a safe and sensitive imaging
technique for CBD pathology, when used to exclude
CBD stones. MRCP is a safe and sensitive imaging
technique for CBD pathology when used to exclude
CBD stones. Miletic et al. [24] reported that MRCP
has the potential to replace diagnostic endoscopic
retrograde cholangiopancreatography in all patients
with suspected choledocholithiasis owing to its high
accuracy. Dalton et al. [25] reported that MRCP should
be the only investigation used to exclude CBD stones.
Makary et  al. and Hallal et  al.  [26,27] suggest that
MRCP may be associated with favorable performance
characteristics (including high sensitivity and negative
predictive value) in the detection of choledocholithiasis
among patients with biliary pancreatitis. Because
MRCP is noninvasive, it is an attractive option for
patients at low risk for choledocholithiasis.
In our study, LC  (without laparoscopic CBD
exploration) was done in 20 (100%) cases, in whom no
CBD dilatation was present (by ultrasound or CT) or
dilated CBD but stones were excluded using MRCP.
There were no intraoperative difficulties, operative
time was close to the time consumed in similar
studies, no intraoperative complications were present
such as bleeding or CBD injury, and postoperative
complications were minor such as one case of minor
bile leak which stopped spontaneously and one
case port site infection which was completely cured
by antibiotics. There were no major postoperative
complications such as jaundice owing to retained
CBD stones or biloma formation because of bile
leakage.
In our study, the range of postoperative hospital stay
was between 1 and 4 days, and this is one of the main
advantages of early cholecystectomy in shortening
the hospital stay and preventing recurrent attacks of
biliary pancreatitis that require readmission to the
hospital.
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Laparoscopic cholecystectomy in pancreatitis Alameldeen et al.  151
In our study, there were no major intraoperative
complications, no conversion to open was done in
any case, and the operative time range was between
30 and 75  min. In the study by Ammori et  al.  [28],
despite increased age and comorbidity and more
frequent adhesions, their data showed no evidence
that intraoperative or postoperative complications
were more frequent in patients with biliary pancreatitis
than in other patients undergoing LC. They consider
that a policy of ‘same‑admission’ cholecystectomy is
appropriate for patients with acute pancreatitis owing
to gallstones.
Surprisingly, despite the release of the UK guidelines
for acute pancreatitis, several studies reported that early
cholecystectomy was performed in only a minority of
patients [29,30].
Surprisingly, in studies from the USA and Australia,
cholecystectomy was performed too late and only in a
minority of patients.
Conclusion
LC in mild acute biliary pancreatitis cases is safe and
should be done during the same hospital admission to
prevent further attacks of pancreatitis.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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