Best to do Cholecystectomy on Initial Hospitalization in Gallbladder Pancreatitis

Background:  Recommendations advocate for cholecystectomy during the index hospital admission for gallstone pancreatitis, but still many patients in the US don’t get the surgery for weeks.
n = 266 pts randomized to have chole during index hospital stay (mean 1 day) or several weeks later (interval chole, mean 27 days).
Endpoints:  gallstone-related complications (pancreatitis, cholangitis, cholecystitis, etc.) or mortality occurred significantly less in the same-admission group (5% vs 17%).  No difference in surgical complications between groups.
Conclusion:  delaying cholecystectomy for gallstone pancreatitis leads to higher rates of preventable complications, with no worse surgical complications in patients with mild pancreatitis.  This is a major change in practice.  In patients who have had severe necrotizing pancreatitis, cholecystectomy should be delayed until active inflammation subsides and fluid collections resolve or stabilize.
Lancet 2015; 386: 1261

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