Significance of optimal timing of laparoscopic cholecystectomy and variations in carbohydrate antigen 19-9 level in patients with non-obstructive mild acute gallstone pancreatitis

Objective To evaluate the significance of optimal timing of laparoscopic cholecystectomy and variations in the serum carbohydrate antigen 19-9 （CA19-9） level during the progression of non-obstructive mild acute gallstone pancreatitis （MAGP）. Methods Clinical data of 181 non-obstructive MAGP patients undergoing early laparoscopic cholecystectomy were retrospectively analyzed. All patients were divided into three groups： study group 1 （amylase（+）+CA19-9（-）, 28 cases）, study group 2 （amylase （+）+CA19-9（+）, 21 cases）, and control group （amylase （-）+CA19-9（-）, 132 cases）. Amylase （+） is defined as more than 3 times of the upper limit of normal value and CA19-9（+） is defined as exceeding the upper limit of normal value. Surgery-related parameters and the changes in the amylase and CA19-9 levels before and after surgery were statistically compared among three groups. Results There was no significant difference in the flatus time, rate of conversion to open cholecystectomy and incidence rate of postoperative complications among three groups （all P > 0.05）. Intraoperatively, the severity of gallbladder, the triangle of Calot and perigallbladder inflammation in the study group 2 was higher compared with those in the other two groups. The operation time, length of hospital stay and intraoperative blood loss in the study group 2 were significantly worse than those in the study group 1 and control group （all P < 0.05）. Postoperative serum levels of amylase and CA19-9 in patients with amylase （+） or CA19-9 （+） were significantly lower than preoperative levels （both P < 0.05）. Conclusions Early laparoscopic cholecystectomy is safe and effective for patients with non-obstructive MAGP. Nevertheless, for those complicated with elevated CA19-9 levels, extensive cautions should be taken for the severity of inflammation and surgical difficulty to avert the incidence of postoperative complications.