THE EFFECT OF TIMING OF LAPAROSCOPIC SURGERY FOLLOWING ACUTE GALLSTONE PANCREATITIS
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In the era of laparoscopic cholecystectomy, the effect of timing of surgery following acute gallstone pancreatitis is the aim of the current study. It was done at the Benha University Hospital in the period from August 1992 to June 1995 . It included 33 selected patients with gallstone pancreatitis, diagnosed by clinical examination, laboratory investigations and imaging study, particularly ultrasonography. The mean age of the patients was 54.7 ± 10.5 years of which 29 were females (87.9%) and 4 were males (12.1%). They were categorized into two groups according to Ranson 's criteria: the first group included 28 patients (84.8%) with mild pancreatitis (Ranson 's criteria 2 or less), and the second group included 5 patients (15.2%) with evere pancreatitis (Ranson's 'criteria 3 or more). Standard medical therapy was advocated to all patients. ERCP was done for 8 patients (24.2%) with stone common bile duct, severe pancreatitis and for those patients with elevated serum bilirubin that did not respond to medical treatment, and required papillotomy and or stone extraction. Laparoscopic cholecystectomy was performed for all patients after clinical and biochemical resolution of the pancreatitis. The procedures done -within one week were considered early operations, while those done after one week were later operations. 7'he postoperative hospital stay was taken as an indirect measure for morbidity. In patients with mild pancreatitis, there seemed to be no differences in complications, conversion rates, or length of postoperative stays in those operated on earlier, compared with those operated on later With no difference in postoperative stay, those operated on earlier obvious had shorter total hospital stays. In patients with severe pancreatitis, those with earlier laparoscopic attempts were converted into open procedures and their postoperative hospital stays were prolonged in comparison to those patients operated upon late. In the current study, there was no mortality whatsoever We concluded that laparoscopic cholecystectomy is a safe procedure when performed after clinical and biochemical resolution of pancreatitis, and is preferably done late in those patients with severe pancreatitis.