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OPTIMAL TIMING AND METHODS OF CHOLECYSTECTOMY FOR BILIARY
PANCREATITIS
Qosimov Nodirxo‘ja Abduqosim ugli
Tashkent Medical Academy Department of Surgical Diseases
Abstract:
Biliary pancreatitis (BP) is a common pathology associated with cholelithiasis.
Cholecystectomy is the main method of preventing relapses, but the question of its optimal
timing and methods remains open. The article considers modern approaches to choosing the
time of surgical intervention, compares laparoscopic and open techniques, and discusses the
role of endoscopic interventions in the treatment of biliary pancreatitis.
Keywords:
biliary pancreatitis, cholecystectomy, laparoscopy, endoscopic retrograde
cholangiopancreatography, cholelithiasis.
Introduction
Biliary pancreatitis develops due to obstruction of the bile ducts by stones, which leads to
the reflux of bile into the pancreatic ducts and activation of pancreatic enzymes.
Cholelithiasis is the main cause of acute pancreatitis, accounting for up to 60% of cases of
the disease [1].
Current clinical guidelines note that cholecystectomy should be performed on all patients
who have had biliary pancreatitis, except for those for whom surgery is contraindicated [2].
However, the timing and technique of the intervention depend on the severity of pancreatitis
and the general condition of the patient.
Optimal timing of cholecystectomy
There are several strategies for choosing the timing of surgery in patients with biliary
pancreatitis:
1. Early cholecystectomy (within 48-72 hours after admission).
• Optimal for patients with mild pancreatitis.
• Helps prevent recurrent attacks and reduce the overall duration of hospitalization.
• Studies show that early cholecystectomy does not increase the risk of complications
compared with delayed surgery [3].2. Delayed cholecystectomy (4-6 weeks after the acute
episode).
• Recommended for severe pancreatitis with necrotic changes.
• Allows for surgery in a more stable patient, reducing the risk of surgical complications [4].
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• Endoscopic papillosphincterotomy (EPST) is often performed before surgery to improve
bile outflow [5].
3. Emergency cholecystectomy.
• Indicated for complicated cases (e.g. purulent cholecystitis, mechanical jaundice,
gallbladder perforation).
• May require extended access if laparoscopic intervention is not possible [6].
Cholecystectomy methods
1. Laparoscopic cholecystectomy
This method is considered the “gold standard” for the treatment of cholelithiasis and
pancreatitis. Its advantages:
• Minimal trauma.
• Rapid patient recovery.
• Reduced risk of postoperative infections.
• Short hospital stay (1–3 days) [7].
2. Open cholecystectomy
It is used in complicated forms of cholelithiasis, the presence of severe inflammation,
adhesions, or failure of laparoscopic access.
• Long rehabilitation period.
• High risk of infectious complications.
• It is used in cases of severe destructive changes in the gallbladder [8].
The role of endoscopic methods
For some patients, endoscopic retrograde cholangiopancreatography (ERCP) with EPST is
indicated before cholecystectomy. This procedure allows:
• To remove stones from the bile ducts.
• To reduce the risk of repeated attacks of pancreatitis.
• To improve the prognosis in case of concomitant choledocholithiasis [9].Comparative
analysis of treatment tactics
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Approach
Advantages
Flaws
Early cholecystectomy
Minimizing
relapses,
reducing the length of
hospitalization
Possibility of complications in
severe pancreatitis
Delayed cholecystectomy
Conducting surgery in a
stable condition
Risk of recurrent attacks before
surgery
Laparoscopic
cholecystectomy
Minimal
trauma,
fast
rehabilitation
Technical
difficulties
may
occur during inflammation
Open cholecystectomy
Possibility
of
implementation in case of
severe inflammation
Highly invasive, long recovery
Development Prospects
Minimally invasive technologies are being actively introduced in modern surgery:
• Robotic surgery, increasing the accuracy of laparoscopic operations.
• Improvement of endoscopic methods for effective removal of stones without the need for
surgical intervention.
• Personalized approach to treatment, taking into account inflammation biomarkers [10].
Conclusion
The choice of the optimal time and method of cholecystectomy for biliary pancreatitis
depends on the severity of the disease and the patient's condition. Laparoscopic
cholecystectomy is the preferred method, but in some cases open surgery or endoscopic
interventions are required. Modern technologies can improve treatment results and reduce
the frequency of relapses.
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