Invited Critique
Nov 2012

Shifting Surgical Paradigms for Cholecystectomy in Mild Gallstone PancreatitisComment on “Early Laparoscopic Cholecystectomy for Mild Gallstone Pancreatitis”

Author Affiliations

Author Affiliation: Department of Surgery, University of California, San Francisco, San Francisco General Hospital, California.

Arch Surg. 2012;147(11):1035. doi:10.1001/archsurg.2012.1637

The article by Falor and colleagues,1 “Early Laparoscopic Cholecystectomy for Mild Gallstone Pancreatitis: Time for a Paradigm Shift,” represents a potentially important retrospective study. By providing real data, Falor and colleagues1 once again show that some of our cherished biases and beliefs may be incorrect. Their study1 examined the impact of early vs delayed laparoscopic cholecystectomy in uncomplicated acute gallstone pancreatitis and demonstrated outcomes that were statistically indistinguishable. Specifically, they found no increase in the number of complications, in the incidence of conversion to open cholecystectomy, or in the need for postoperative of endoscopic retrograde cholangiopancreatography. The article did demonstrate a significant 3-day decrease in hospital length of stay in the early laparoscopic cholecystectomy group. They concluded that a laparoscopic cholecystectomy can be safely performed early in gallstone pancreatitis, without waiting for normalization of laboratory values.

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