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General Surgery · Pancreas: gallstone pancreatitis timing
Sample itemA 44-year-old woman is admitted with mild acute gallstone pancreatitis. She improves in 3 days, tolerates a diet, and has no necrosis or collections on imaging. When should laparoscopic cholecystectomy be performed?
Original practice item, not a recalled exam question. Nothing here is recorded.
The answer and the reasoning
D. During the same admission once she has recovered
In mild gallstone pancreatitis, cholecystectomy during the same admission reduces the risk of recurrent pancreatitis and readmission. In contrast, in severe or necrotising disease surgery is delayed until collections resolve or mature, usually about 6 weeks. Waiting for months exposes the patient to repeated attacks.
Option by option
A. After 6 months to allow the inflammation to settle
A long delay risks recurrent attacks and is reserved for severe disease with collections.
B. Never, since sphincterotomy replaces it in all fit patients
Sphincterotomy lowers recurrence but is for patients unfit for surgery and does not replace cholecystectomy.
C. Only if she has a second attack
Waiting for a second attack accepts avoidable morbidity, as recurrence rates are high without surgery.
D. During the same admission once she has recovered (correct)
Correct. Same-admission cholecystectomy prevents recurrent biliary pancreatitis in mild disease.
Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.
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