European Journal of Cardiovascular Medicine

Acute pancreatitis is an inflammatory condition of the pancreas with a wide spectrum of severity, ranging from mild self-limiting illness to severe life-threatening complications. Gallstones are one of the most frequent causes of acute pancreatitis, accounting for approximately 35–60% of all cases [1,2]. The pathogenesis of acute gallstone pancreatitis (AGP) involves transient obstruction of the ampulla of Vater by migrating gallstones, leading to the activation of pancreatic enzymes and inflammation [3].

Cholecystectomy is the definitive treatment to prevent recurrence of gallstone-related complications, including biliary colic, cholangitis, and recurrent pancreatitis. However, the ideal timing for cholecystectomy following an episode of AGP remains a subject of ongoing debate. Performing cholecystectomy early—during the index hospital admission—has been proposed to minimize the risk of recurrent biliary events and readmissions [4]. In contrast, delayed cholecystectomy is traditionally favoured to allow the resolution of local inflammation and reduce operative difficulty [5,6].

Several studies have indicated that early cholecystectomy in patients with mild AGP is associated with reduced hospital stay and comparable complication rates to delayed surgery [7]. Moreover, delaying cholecystectomy has been linked with a higher incidence of recurrent biliary events, posing additional morbidity and increased healthcare burden [8]. On the other hand, concerns regarding increased operative difficulty and potential complications during early surgery continue to influence clinical decisions [9,10].

Given these considerations, this study aims to evaluate and compare the clinical outcomes of early versus delayed cholecystectomy in patients with mild to moderate AGP. The primary focus is on hospital stay, recurrence of biliary events, intraoperative challenges, and postoperative complications.

Study Design and Setting: This prospective, comparative study was conducted at the Department of General Surgery in a tertiary care. Written informed consent was secured from all participants.

Study Population: A total of 80 adult patients diagnosed with mild to moderate acute gallstone pancreatitis (AGP) were enrolled based on predefined inclusion and exclusion criteria. Diagnosis was made based on clinical features, elevated serum amylase or lipase levels (greater than three times the normal), and ultrasonographic evidence of gallstones without other evident causes of pancreatitis.

Inclusion Criteria:

• Age between 18 and 65 years
• Diagnosis of mild to moderate AGP as per the Revised Atlanta Classification
• Ultrasonographic evidence of gallstones
• Hemodynamically stable patients

Exclusion Criteria:

• Severe pancreatitis (organ failure >48 hours or necrosis)
• History of previous cholecystectomy
• Pregnancy
• Coagulopathy or unfit for general anesthesia
• Pancreatitis due to causes other than gallstones

Grouping and Intervention: Patients were randomly assigned into two groups (n = 40 each) using a computer-generated randomization list:

• Group A (Early Cholecystectomy): Underwent laparoscopic cholecystectomy within 7 days of symptom onset, during the index admission.
• Group B (Delayed Cholecystectomy): Discharged after conservative management and scheduled for surgery 4–6 weeks later, once the inflammation had resolved.

All patients received standard conservative management including intravenous fluids, analgesics, and antibiotics when indicated.

Parameters Assessed: The following clinical parameters were recorded and compared:

• Duration of hospital stay
• Operative time
• Intraoperative difficulty (graded on a 5-point scale)
• Conversion to open surgery
• Postoperative complications (e.g., bile leak, wound infection, intra-abdominal abscess)
• Recurrence of biliary events before surgery in the delayed group

Statistical Analysis: Data were entered in Microsoft Excel and analyzed using SPSS version 26.0 (IBM Corp., Armonk, NY, USA). Continuous variables were expressed as mean ± standard deviation and compared using the independent samples t-test. Categorical data were analyzed using the Chi-square or Fisher’s exact test. A p-value of less than 0.05 was considered statistically significant.

A total of 80 patients were included in the study, equally distributed between Group A (early cholecystectomy, n=40) and Group B (delayed cholecystectomy, n=40). Both groups were comparable in terms of baseline demographic characteristics such as age and gender distribution.

Hospital Stay and Operative Findings: The mean hospital stay was significantly shorter in Group A (6.3 ± 1.4 days) compared to Group B (9.7 ± 1.6 days), with a p-value < 0.001 (Table 1). The mean operative time was slightly longer in Group A (64.5 ± 10.2 minutes) compared to Group B (61.2 ± 9.4 minutes), but this difference was not statistically significant (p=0.148). The rate of conversion to open cholecystectomy was similar in both groups, with 2 cases (5%) in Group A and 1 case (2.5%) in Group B.

Postoperative Complications and Recurrence: Postoperative complications occurred in 3 patients (7.5%) in Group A and 5 patients (12.5%) in Group B, showing no statistically significant difference (p=0.45). However, recurrence of biliary symptoms such as colic or pancreatitis before surgery was observed in 9 patients (22.5%) in Group B, whereas only 1 patient (2.5%) in Group A reported similar events (p=0.007) (Table 2).

Table 1: Comparison of Hospital Stay and Operative Parameters

Source: Hospital surgical records and intraoperative notes.

Table 2: Postoperative Complications and Recurrence of Biliary Events

Source: Clinical follow-up and patient readmission records.

As shown in Table 1, early cholecystectomy significantly reduced the duration of hospitalization without increasing the conversion rate or operative time. Additionally, Table 2 highlights that delaying surgery led to a higher incidence of recurrent biliary episodes before definitive surgical management.

The present study evaluated the outcomes of early versus delayed cholecystectomy in patients diagnosed with mild to moderate acute gallstone pancreatitis (AGP). The findings demonstrated that early cholecystectomy significantly reduced hospital stay and recurrence of biliary events without increasing operative time or complication rates. These results are consistent with previous studies suggesting the safety and efficacy of early surgical intervention in AGP cases.

Gallstones remain a leading etiology of acute pancreatitis, with recurrent attacks common if the causative factor is not promptly addressed [1,2]. Cholecystectomy is considered the definitive management to prevent recurrence, but the optimal timing of surgery has been controversial [3]. Early cholecystectomy, typically performed during the index admission, is increasingly supported by evidence for its benefits in mild AGP [4].

Our study observed a significant reduction in hospital stay in the early cholecystectomy group. This aligns with the findings of Aboulian et al., who reported shorter hospitalization in early surgery groups with no increase in operative complications [5]. Similarly, da Costa et al., in the PONCHO trial, found early intervention reduced readmissions and avoided delays without elevating surgical risks [6]. These benefits contribute to decreased healthcare costs and improved patient satisfaction [7].

Another key observation was the lower rate of recurrent biliary events in the early cholecystectomy group. Delayed surgery has been associated with a higher risk of recurrent pancreatitis, biliary colic, and cholangitis, leading to additional interventions and increased morbidity [8,9]. Bansal et al. also reported significantly fewer readmissions in patients who underwent early cholecystectomy [10].

In contrast, concerns have been raised about the technical difficulties of operating during the acute inflammatory phase. However, our findings showed that operative time and conversion to open surgery rates were not significantly different between the two groups, which supports prior studies indicating that mild inflammation does not compromise the safety of laparoscopic cholecystectomy [11,12]. The American Gastroenterological Association has also endorsed early cholecystectomy for mild AGP, highlighting its favourable outcomes [13].

Postoperative complications in our study, including wound infection and bile leak, were comparable between groups. This observation is in line with previous meta-analyses that have not shown any significant increase in surgical complications associated with early intervention [14,15].

Overall, the evidence favours early cholecystectomy in patients with mild to moderate AGP, offering reduced hospital stay, lower recurrence of biliary events, and no increase in adverse outcomes. The reluctance toward early surgery often stems from overestimation of surgical risks during the inflammatory phase, which may not be substantiated by clinical data. Therefore, careful patient selection, proper perioperative monitoring, and experienced surgical teams can facilitate the safe implementation of early cholecystectomy protocols.

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