Timing of cholecystectomy in biliary pancreatitis

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 choelcystectomy

d) Early cholecystectomy increases technical complications

 Ans b

"Poncho trial " answers this question

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

SKF page 1079

Bile duct injuries in cholecystectomy

Q True about Bile duct injuries in cholecystectomy

a) Only 15% are recognized at the time of surgery

b)Routine  Operative cholangiography  definitely reduces the incidence of bile duct injury

c) In incomplete obstruction of bile duct,  jaundice occurs early

d) Surgical outcome depends on timing of surgery

Answer for premium members

After cholecystectomy complications can occur in 15%. Identification and management of bile duct injuries is very important. This question and subsequent discussion has been routinely asked in many exams