LOS ANGELES — When cholecystectomy is indicated following gallstone pancreatitis, the severity of the disease should determine timing of the surgery, Nicholas N. Nissen, M.D., said at the 12th International Symposium on Pancreatic and Biliary Endoscopy sponsored by the Cedars-Sinai Medical Center.
Surgical residents are traditionally taught to perform cholecystectomy before hospital discharge—and definitely within 4 weeks of symptom onset—to avoid complications.
That rule still holds for patients with mild or moderate gallstone pancreatitis.
But for patients with severe disease, it's a different story, noted Dr. Nissen, assistant surgical director of multiorgan transplantation and a specialist in minimally invasive liver and pancreas surgery at the medical center.
“Cholecystectomy in these patients should clearly wait until severe inflammation and organ dysfunction are resolved. It should certainly not be done in the first few weeks [after the onset of symptoms of severe gallstone pancreatitis],” said Dr. Nissen, who also serves on the surgical faculty at the University of California, Los Angeles.