Necrotizing biliary pancreatitis: time for cholecystectomy

Acute necrotizing or necrotic-hemorrhagic pancreatitis accounts for 10-25% of all forms of acute pancreatitis, with High mortality and morbidity due to Multi-visceral failure syndrome and Superinfection of necrosis.Biliary origin most frequent in TUNISIATime for cholecystectomy is a controversial subject, There is No consensus with a high level of evidenceWe classically wait the ad integrum restitution of flows (about 3 months) to do the cholecystectomy, but in this time many patients develop recurrent pancreatitis, which is usually more severe before undergoing cholecystectomy. We propose to conduct a randomised, single-blind, unilateral controlled trial to assess the safety of early cholecystectomy in acute necrotising pancreatitis compared with late cholecystectomy. o Treatment tested (Group A): early cholecystectomy o Control group (Group B): delayed cholecystectomy Early cholecystectomy = during the same hospitalisation (within 15 days of symptomatology). Delayed cholecystectomy = after restitution ad integrum of the necrosis flows.Our Primary endpoint:perioperative complications (hemorrhage, biliary wound and superinfection of necrosis flows)