Early Laparoscopic Cholecystectomy For Mild And Moderate Gallstone Pancreatitis: A Systematic Review And Meta-analysis

Background: Laparoscopic cholecystectomy(LC)is required to be carried out in gallstone pancreatitis;however,the timing of LC is controversial.Purpose: To evaluate the efficacy and safety of early LC for mild and moderate gallstone pancreatitis.Data Sources: Searches of Pub Med,EMBASE,the Cochrane Library,CNKI,VIP,WANFANG DATA,CBM,Clinical Trials.gov,and Isrctn.com prior to 7 November2020.Study Selection: Randomized controlled trials in English and Chinese that compared early LC with delayed LC in mild and moderate gallstone pancreatitis.Data Extraction: Primary outcomes were recurrent biliary events(cholecystitis,biliary colic,recurrent pancreatitis,choledocholithiasis)and perioperative complications(surgical site infection,bile leak,bleeding).Secondary outcomes included length of hospital stay,duration of procedure,conversion to an open cholecystectomy.Data Synthesis: Eight trials met the inclusion criteria.When LC was carried out within72 h during the same admission,early LC was associated with a significant improvement in recurrent biliary events(RR: 0.21,95% CI: 0.05 to 0.81)and length of hospital stay(MD:-3.46,95% CI:-6.02 to-0.91)compared to delayed LC.Compared to delayed LC,early LC did not show a significant improvement in perioperative complications(RR: 1.38,95% CI: 0.57 to 3.37),duration of procedure(MD: 0.21,95%CI:-8.52 to 8.94),and conversion to an open cholecystectomy(RR: 0.96,95% CI: 0.37 to 2.53).Conclusion: Early LC(especially within 72h)is more beneficial for mild and moderate gallstone pancreatitis;at the same time,it is as safe as delayed LC in perioperative complications,duration of procedure,and conversion to an open cholecystectomy.