Ishaan Maitra1, Grace Bennett1, Camilo Morais2, Ravindra Date1

1Department of General Surgery, Lancashire Teaching Hospitals, Preston, United Kingdom
2University of Central Lancashire School of Pharmacy and Biomedical Sciences, Preston, United Kingdom


Objective: The literature predicting difficulties during Laparoscopic Cholecystectomy (LC) for Acute Gallstone Pancreatitis (AGP) is mainly focused on the timing of operation. In our experience, LC for AGP is rarely difficult irrespective of the timing of operation. The aim of this study was to assess intra- operative difficulties in mild AGP patients to verify this observation.

Material and Methods: A retrospective analysis of all consecutive patients who underwent LC for mild AGP between 2014 and 2018 in a single centre was performed. Patients with known alcohol abuse, post-endoscopic retrograde cholangiopancreaticography (ERCP) induced pancreatitis, and those with chronic pancreatitis were excluded. Univariate weighted analysis was performed with 11 factors, with a linear threshold boundary defined as the mean distance between the four degrees of difficulty (DoD 1-4).

Results: Ninety-six patients (Male= 33, median age= 56; Female= 63, median age= 52) were analysed. Majority of the patients were an ASA of two (n= 50; 52%) with a median BMI of 28 (range 18-50). Five procedures were technically difficult (DoD≥ 3) and only one procedure was converted to open operation. Univariate analysis showed that duration of pancreatitis >6 days (p= 0.002) and evidence of acute cholecystitis (p< 0.05) are associated with a difficult LC (DoD≥ 3). The rest of the factors did not influence DoD.

Conclusion: Based on this result, we suggest that LC for mild AGP is rarely difficult, and this finding can be used in practice for selecting these patients for training lists.

Keywords: Acute gallstone pancreatitis, degree of difficulty, laparoscopic cholecystectomy


Ethics Committee Approval

It is stated by NHS Lancashire Teaching Hospitals that this study is considered to be Service Evaluation which means designed and conducted care and does not require ethical review.

Peer Review

Externally peer-reviewed.

Author Contributions

Concept - R.D.; Design - R.D.; Supervision - R.D.; Data Collection and/or Processing - I.M., G.B.; Analysis and/or Interpratation - C.M.; Literature Review - R.D., I.M.; Writing Manuscript - I.M.; Critical Reviews - I.M., R.D.

Conflict of Interest

The authors declare that they have no conflict of interest.

Financial Disclosure

The authors declared that this study has received no financial support.