Meta-analysis Of Timing Of Cholecystectomy For Mild Biliary Pancreatitis

Objective:Acute pancreatitis is a common surgical acute abdomen,80% of the patients with pancreatitis are mild acute pancreatitis.In China,the most common cause of acute pancreatitis is biliary origin,and laparoscopic cholecystectomy is the preferred method to treat acute biliary pancreatitis and reduce its recurrence.However,the timing of the operation is still controversial.In this study,the safety and effectiveness of laparoscopic cholecystectomy for mild biliary pancreatitis within 72 hours of admission(early surgery group)and after 72 hours of admission(delayed surgery group)were evaluated and compared by Meta analysis,in order to provide evidence-based medicine for clinical decision-making.Methods:Through the Internet in the Cochrane Library,such as Pub Med,Embase database in English and Chinese biomedical database,China academic journal full-text database,database knowledge service platform of ten thousand Chinese database retrieve from the database to the March 2021 on light early laparoscopic cholecystectomy gallstone pancreatitis and extension of laparoscopic cholecystectomy treatment related literature.According to the established inclusion and exclusion criteria,relevant literatures were strictly screened and relevant data were extracted,including the original research data of patients with mild biliary pancreatitis,such as length of stay,incidence of complications,conversion rate of laparotomy,duration of surgery,utilization rate of ERCP and readmission rate.Rev Man5.3 software was used for statistical analysis to compare the incidence of complications,length of hospital stay,conversion rate,operation time,utilization rate of ERCP,readmission rate and other levels of results between the early surgery group and the delayed surgery group.Results:18 articles were included in this study,a randomized controlled trial of 8,10)were retrospectively analyzed,and a total of 2530 patients with the meta analysis,according to the results of early surgery group and delayed treatment rate of the complications,transfer laparotomy,operation time and the use of ERCP,differences had no statistical significance(P > 0.05),compared with delayed treatment,early treatment in patients with shorter hospitalization time(SMD = 1.73;95% CI: 2.43 ～ 1.02;P<0.00001)with a lower rate of readmission(RR=0.34;95% CI: 0.14 ～ 0.84;P=0.02),and the incidence of gallstone related complications,including biliary colic,recurrent pancreatitis,cholecystitis,jaundice,and cholangitis in the delayed group included in the literature,during the waiting period was 26.00%.Conclusion:Early laparoscopic cholecystectomy in patients with light of gallstone pancreatitis is safe and effective,can shorten the length of hospital stay,reduce the delay waiting for gallstone during surgery complications and readmission rate,but according to the current data can’t prove can reduce light gallstone pancreatitis complication rates,transit operation rate,operation time and the use of perioperative ERCP,the study of large amounts of data were retrospectively analyzed from system,could lead to potential deviation,so the future still need large-scale,high quality randomized controlled trial to elucidate the safety and efficacy of early laparoscopic cholecystectomy for mild biliary pancreatitis.In addition,due to the influence of the medical level in different regions and countries,indications and contraindications should be strictly controlled,and the timing of surgery should be determined according to the clinical situation.