Optimal Timing to Perform Cholecystectomy in Patients with Acute Biliary Pancreatitis

Background: Acute biliary pancreatitis accounts for nearly 50% of acute pancreatitis cases, primarily caused by gallstones and biliary sludge. Cholecystectomy remains the definitive treatment to prevent recurrent biliary events, but the optimal timing of surgery remains debated.Objective: This study aimed to evaluate the optimal timing of cholecystectomy in patients with mild to moderate acute biliary pancreatitis, comparing early cholecystectomy during index admission to delayed cholecystectomy.Methods: A prospective cohort study was conducted over 24 months at Combined Military Hospital, Kohat, Pakistan. A total of 126 patients aged 18 years and older, diagnosed with mild to moderate acute biliary pancreatitis, were included. Patients with severe pancreatitis, ICU admissions, or requiring ERCP were excluded. Patients were divided into two groups: index admission cholecystectomy and delayed cholecystectomy. Data were analyzed using SPSS 25 with chi-square tests applied. A p-value of <0.05 was considered statistically significant.Results: Recurrent pancreatitis occurred in 0 patients in the early group versus 41 patients in the delayed group (p < 0.001). The mean hospital stay was significantly shorter in the early group (5.92 vs 12.31 days, p < 0.001).Conclusion: Early cholecystectomy significantly reduced recurrent biliary events and shortened hospital stay in patients with mild to moderate acute biliary pancreatitis without increasing complications.