OUTCOME OF EARLY VS DELAYED CHOLECYSTECTOMY AMONG PATIENTS PRESENTED WITH MILD ACUTE BILIARY PANCREATITIS IN A TERTIARY CARE HOSPITAL

Abstract

Background and Objective: The optimal timing for cholecystectomy in mild acute biliary pancreatitis (ABP) remains debated. This study aimed to compare the outcomes of early cholecystectomy (within 7 days of presentation) versus delayed cholecystectomy (at 4 weeks) in terms of recurrent biliary events and persistent choledocholithiasis.

Methods: This randomized clinical trial was conducted at the Department of General Surgery, Fauji Foundation Hospital, Rawalpindi. A total of 170 patients with mild ABP were randomized into an early group (n=85) or a delayed group (n=85). The primary outcomes measured were the recurrence of biliary events and the incidence of choledocholithiasis. Data were analyzed using SPSS v25.0. Outcome were compared using chi-square tests, considering a p-value ≤0.05 as significant.

Results: The recurrence of biliary events was higher in the delayed group (12.9%) compared to the early group (4.7%), though this difference was not statistically significant (p=0.058). However, the incidence of choledocholithiasis was significantly higher in the delayed group (17.6%) than in the early group (5.9%) (p=0.017). Stratification analysis revealed that males and overweight patients in the delayed group were at a significantly higher risk of developing choledocholithiasis.

Conclusion: Early cholecystectomy within one week of presentation for mild ABP is associated with a significantly lower risk of persistent choledocholithiasis compared to a delayed approach. While not statistically significant, a strong trend towards reduced recurrent biliary events was also observed with early intervention. These findings advocate for early surgical management to prevent serious complications, particularly in high-risk subgroups.