Delayed cholecystectomy for gallstone pancreatitis: re-admissions and outcomes

Objective: Timing of cholecystectomy after gallstone pancreatitis and use of pre-operative cholangiography varies considerably between surgeons. We examined outcomes in a district general hospital where most patients underwent delayed cholecystectomy following pre-operative cholangiography. Methods: A retrospective review of admissions with gallstone pancreatitis over a 5-year period was conducted. Results: A total of 77 patients with gallstone pancreatitis were identified of whom 58 underwent laparoscopic cholecystectomy (LC) at a median of 67.5 days after index admission. Of these patients, 21% had unplanned re-admission while awaiting LC rising to 25% of those who waited for more than 4 weeks. Surgery at 4 weeks would have been associated with a 6% re-admission rate. Re-admissions were due to pancreatitis (4 cases), cholecystitis (3 cases), biliary colic (4 cases) and pseudocyst (1 case). In all, 49 patients had pre-operative cholangiography and 13 had pre-operative endoscopic extraction of stones from the common bile duct. Conclusions: Delay of LC for greater than 4 weeks after gallstone pancreatitis is associated with a high, unplanned re-admission rate, even with liberal use of pre-operative cholangiography.