Objectives: Biliary stones are the leading cause of acute pancreatitis.
Although cholecystectomy and selective endoscopic retrograde cholangiography
(ERC) comprise the current treatment in patients with acute blliary
pancreatitis (ABP), the time of intervention is still controversial. The aim of
the study is to evaluate the policy of laparoscopic cholecystectomy for patients
with ABP during the initial admission.
Methods: The study was carried out in the period November 2004-
October 2006. Thirty patients with ABP were subjected to laparoscopic
cholecystectomy during the index admission after clinical and biochemical
resolution of the attack. The severity of the disease was assessed using
Ranson' criteria; 3 or less indicates mild pancreatitis, while more than
3 is considered severe pancreatitis. ERC and endoscopic sphincterotomy
(ES) are used on a selective basis pre- and post-operatively. Standard 4-
ports technique was used; timing for surgery, operative difficulty, conversion
rate, post-operative morbidity and mortality were evaluated.
Results: A total of 30 patients with the diagnosis of ABP were included
in this study. Twenty-five patients (83.3%) were categorized as having
mild pancreatitis (Ranson' criteria < 3) and 5 patients (16.7%) were categorized
as having severe pancreatitis (Ranson' criteria > 3). All patients
were managed conservatively and underwent laparoscopic cholecystectomy
after clinical and biochemical resolution of the attack on the same
hospital admission. The time from admission to the operating room
ranged from 3-8 days (median 5.1) in mild pcmcreatitis, while in severe pancreatitis; it ranged from 7-28 days (median 20.2). ERC and ES were
performed on selective basis for 6 patients pre-operatively and in 2 patients
post-operatively (26.6%). Magnetic resonance cholangiopancreatography
(MRCP) was also done on selective basis to clear the anatomy of
the region of ampulla of Vater in 4 patients (13.3%) for whom ultrasound
(US) was not decisive. Laparoscopic cholecystectomy was feasible in spite
of edema.. inflammation and adhesion. The rates of conversion, morbidity
and mortality were 6.6%, 33.3% and 3.3%, respectively.
Conclusion: Definitive treatment of ABP can be accomplished effectively
and safely by cholecystectomy following clinical and biochemical
improvement with acceptable morbidity and mortality during the same
admission. |
