Studies of the treatment of AMBP have shown the importance of LC in reducing the rate of recurrence. However, the optimal timing for LC is yet to be ascertained. The research presented here confirms that early LC during the same admission is safe for AMBP and could shorten the overall hospital stay.
Over the past decades, studies focused on the optimal timing of LC for AMBP have attracted much attention. Owing to the fear of increasing perioperative risks, many surgeons preferred to perform delayed LC after AMBP.[19, 20] However, this approach was associated with higher recurrence of biliary-related events, especially recurrent ABP. A previous meta-analysis showed that 18% of patients were readmitted after biliary-related events.[13] Therefore, most recent studies advise early LC after AMBP. A prospective study conducted by Aboulian et al. demonstrated that LC within 48 h of admission is safe.[16] The PONCHO study also showed that same-admission LC could reduce the rate of recurrent biliary pancreatitis.[21] The guideline of the British Society of Gastroenterology recommended LC within 2 weeks of discharge,[15] whereas others provided different recommendations. Thus it is unclear whether LC performed within 72 h from onset of symptoms is safe for AMBP. A recent Cochrane review demonstrated that LC performed within 3 days was safe and could shorten the total hospital stay.[22] To our best knowledge, there are only four randomized controlled trials (RCTs) in the previous literature. It is thus necessary and important to conduct a retrospective study given the difficulty of predicting the progression of pancreatitis. In our retrospective study, LC performed within 72 h demonstrated safety equal to that performed after 72 h. According to the Clavin classification of postoperative complications, there were no significant differences in terms of major complications. BDI and postoperative bile leakage, the main biliary-related complications, showed no differences between our two groups. Most previous studies measured the severity of biliary pancreatitis using the Ranson score. The Ranson criteria require 48 h for completion, thus missing the potentially valuable early treatment. In 2008, the BISAP was proposed to predict severe acute pancreatitis.[18] Previous studies have demonstrated that the BISAP score is a reliable tool for identifying acute pancreatitis patients.[23, 24] The present study is the first to use BISAP for classification of pancreatitis, which can potentially shorten the waiting time before surgery.
Consistent with previous research, our study showed that early LC could reduce the rate of recurrent pancreatitis. The study conducted by Ito et al. showed that 32% of patients were readmitted because of pancreatitis while waiting for LC.[25] Another concern for early surgery is that it may increase postoperative ERCP. Two patients from each of our groups underwent postoperative ERCP, with no discernible significant difference. However, future studies with larger samples are necessary.
The possible increase in the COC rate is considered the reason why many surgeons choose delayed LC. Previous studies demonstrated that early LC may be more technically challenging because of the edema and inflammation.[26, 27] This view is changing as laparoscopic technology continues to advance. In a study by Aksoy et al., the main reason for COC in the early group was obscure anatomy (including Calot’s triangle), and no significant differences from the delayed group were observed,[28] in line with the results of our study, where the main reason for COC was difficulty in detecting Calot’s triangle. Compared with later LC, early LC was not associated with an increase in detecting Calot’s triangle.
One advantage of early LC is that it leads to a shorter hospital stay. Previous retrospective and prospective studies showed that earlier LC was associated with decreasing stays in hospital.[28, 29] The conclusion of these studies, namely that earlier surgery results in a shorter hospital stay without an increase in complication rates, is consistent with the inference of the present study.