Bile duct

Timing of cholecystectomy in biliary pancreatitis

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Q) What is true regarding timing of cholecystectomy in biliary pancreatitis ?

a) Cholecystectomy should be done before discharge in severe pancreatitis to prevent recurrent attacks

b) Cholecystectomy should be done in same admission as pancreatitis when severe disease is excluded

c) Early cholecystectomy has been shown to have more complications than interval cholecystectomy

d) Early cholecystectomy increases technical complications

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Questions on Bile ducts?

 Ans b

"Poncho trial " answers this question of timing of cholecystectomy in biliary pancreatitis 

Early cholecystectomy (just before discharge, when the patient has recovered and severe disease excluded), compared to interval cholecystectomy, effectively reduces---

  1. The rate of recurrent gallstone-related complications in patients with mild biliary pancreatitis,
  2. low added risk of complications.

Evidence on the timing of cholecystectomy in severe pancreatitis is scarce. Cholecystectomy is recommended after all signs of pancreatic necrosis have been resolved or if they persist more than 6 weeks

  • Cholecystectomy during the same admission is recommended for patients with mild biliary pancreatitis to prevent recurrent attacks.
  • In cases of severe pancreatitis, surgery is generally delayed until the inflammation subsides.
  • Studies have shown that early cholecystectomy during the same admission for mild to moderate biliary pancreatitis does not increase complications compared to delayed or interval cholecystectomy.

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