Surgery News - May 2008 - (Page 9)

M AY 2 0 0 8 • SURGERY NEWS GENERAL SURGERY 9 Don’t Delay Cholecystectomy for Biliary Pancreatitis BY ROBERT FINN Else vier Global Medical Ne ws H U N T I N G T O N B E A C H , C A L I F. — It’s better to perform a cholecystectomy in a patient with biliary pancreatitis during the patient’s first hospital admission than to wait several weeks, according to a study presented by Dr. Kaori Ito at the Academic Surgical Congress. Current guidelines suggest that it may be acceptable to discharge the patient after resolution of the pancreatitis and then wait 2-4 weeks to perform the operation (Gut 2005;54:1-9; Gastroenterology 2007; 132:2019-21). But in a retrospective study, Dr. Ito of Harvard Medical School, Boston, and her colleagues found that delays in cholecystectomy were associated with a high incidence of gallstone-related events, a longer overall length of stay, and worse Continued from previous page Dr. DePaula disclosed that he is a consultant to Covidien. Dr. DePaula said that although he and his colleagues did not compare the two groups, they speculated that the diverted version would be more effective than the standard version because it influences more of the components of the pathophysiologic mechanisms of the disease. In a second presentation at the meeting, Dr. DePaula examined a larger group of 69 patients who had undergone the diverted version of the operation (including the 28 patients in the other study). These patients had a mean age of 51 years and a mean duration of type 2 diabetes of 11 years (range of 3-18 years). Of the 69 patients, 30 (43%) used insulin therapy. The patients’ average HbA1c dropped from 8.7% before the operation to 5.9% after a mean follow-up period of nearly 22 months. Diabetes remission (HbA1c less than 6%) occurred in 65%. Another 31% had adequate glycemic control with an HbA1c of 6%-7%. Other laboratory values improved significantly over the course of follow-up, including fasting plasma glucose (from 208 to 102 mg/dL), postprandial glucose (from 305 to 141 mg/dL), triglycerides (from 236 to 106 mg/dL), and LDL cholesterol (114 to 82 mg/dL). Macroalbuminuria and/or microalbuminuria resolved in most patients. The operation also reduced insulin resistance significantly based on scores derived with the Homeostatic Model Assessment of Insulin Resistance index. The patients’ mean BMI dropped from about 26 to 21 kg/m2. No patients had malnutrition, although some had iron and calcium deficiencies. Side effects stemming from inadequate jejunalization of the ileal segment occurred in the early postoperative period in some patients. Dehydration was a common problem for the first 15 days. In both studies, no patients required conversion to open surgery, and patients stayed in the hospital for a mean of about 3 days. Major postoperative complications occurred in six patients in the first study and in five patients in the second study. No deaths occurred. postoperative outcomes. Furthermore, performing endoscopic sphincterotomy does not eliminate the risk of recurrent pancreatitis or other gallstone-related events, Dr. Ito said. The study included 281 patients with biliary pancreatitis; those with necrotizing pancreatitis were excluded. Of the study patients, 162 (group A) underwent cholecystectomy during their initial admission and the other 119 (group B) underwent cholecystectomy on a subsequent admission. The two groups were similar in demo- graphics, comorbidities, and the severity of pancreatitis. A significantly larger proportion in group A was female (72% vs. 61%). In group B, during the interval between discharge and cholecystectomy, 39 of the patients (33%) experienced a gallstone-related event, and 16 of those patients had recurrent pancreatitis. Fifty percent of the patients experiencing recurrent pancreatitis did so within 4 weeks of initial discharge. Group A and group B differed significantly on total length of hospital stay: 5 days on average for group A and 7 days for group B (including both hospital admissions). Patients in group A also fared better than those in group B in terms of postoperative recurrence of biliary pancreatitis (3% vs. 10%) and reoperation (0% vs. 3%). Endoscopic sphincterotomies were performed in 42 (35%) of the group B patients during the initial hospital admission. The total proportion of gallstone-related events did not differ between the patients who underwent a sphincterotomy and those who did not. Dr. Ito stated she had no disclosures. http://www.surgitel.com http://www.surgitel.com

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Surgery News - May 2008 Contents New Lung Approach Speeds Extubation Innovative GI Procedures May Improve Diabetes Quality Programs Differ on Risk Data Crystal Ball Medical Modeling Ventricular Valve Taking Stock

Surgery News - May 2008

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