Home E-Weekly April 18, 2017

Remove That Gallbladder? Not So Fast

Published: April 17, 2017

MINIMALLY INVASIVE Personalized medicine might limit the number of unnecessary cholecystectomies.

Some people with gallstone pancreatitis are fine years later without gallbladder removal, according to a study published in the American Journal of Gastroenterology — a finding that makes it fair to question whether the standard treatment of removing the gallbladder within 30 days of gallstone pancreatitis is overly aggressive.

Patients suffering from acute biliary pancreatitis often undergo cholecystectomy within 4 weeks of diagnosis, a timing that is in accordance with accepted clinical guidelines.

Researchers at Johns Hopkins Medicine in Baltimore, Md., reviewed the outcomes of 17,000 cases of acute biliary pancreatitis diagnosed between 2010 and 2013. Of the 78% of patients who had their gallbladders removed within a month of the initial diagnosis, less than 10% required follow-up treatment for pancreatitis. Of the 3,700 patients who did not undergo cholecystectomy within 30 days of diagnosis, about 1,200 ended up having their gallbladders removed within 6 months. However, nearly 2,500 patients who did not have the surgery — because of a lack of resources or surgeon or patient preference — still had not undergone the procedure 4 years later.

More research is needed to determine why some patients who didn't undergo surgery experienced recurrence of acute biliary pancreatitis and some did not, says Susan Hutfless, PhD, an assistant professor of medicine at Johns Hopkins and the principal investigator. She says the study highlights a potential opportunity to adjust current standards of care through the personalization of cholecystectomy timing.

"But for now," she adds, "there is clear evidence that the current guidelines are beneficial to patients and should be followed."

Daniel Cook

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