Pancreatitis of biliary origin, optimal timing of cholecystectomy (PONCHO trial): study protocol for a randomized controlled trial

Pancreatitis of biliary origin, optimal timing of cholecystectomy (PONCHO trial): study protocol for a randomized controlled trial

Trials, November 2012

23181667

Stefan A Bouwense, Marc G Besselink, Sandra van Brunschot, Olaf J Bakker, Hjalmar C van Santvoort, Nicolien J Schepers, Marja A Boermeester, Thomas L Bollen, Koop Bosscha, Menno A Brink, Marco J Bruno, Esther C Consten, Cornelis H Dejong, Peter van Duijvendijk, Casper H van Eijck, Jos J Gerritsen, Harry van Goor, Joos Heisterkamp, Ignace H de Hingh, Philip M Kruyt, I Quintus Molenaar, Vincent B Nieuwenhuijs, Camiel Rosman, Alexander F Schaapherder, Joris J Scheepers, Marcel BW Spanier, Robin Timmer, Bas L Weusten, Ben J Witteman, Bert van Ramshorst, Hein G Gooszen, Djamila Boerma, for the Dutch Pancreatitis Study Group

After an initial attack of biliary pancreatitis, cholecystectomy minimizes the risk of recurrent biliary pancreatitis and other gallstone-related complications. Guidelines advocate performing cholecystectomy within 2 to 4 weeks after discharge for mild biliary pancreatitis. During this waiting period, the patient is at risk of recurrent biliary events. In current clinical practice, surgeons usually postpone cholecystectomy for 6 weeks due to a perceived risk of a more difficult dissection in the early days following pancreatitis and for logistical reasons. We hypothesize that early laparoscopic cholecystectomy minimizes the risk of recurrent biliary pancreatitis or other complications of gallstone disease in patients with mild biliary pancreatitis without increasing the difficulty of dissection and the surgical complication rate compared with interval laparoscopic cholecystectomy.