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 1996. 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 (84.1
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. The postoperative hospital
slay 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 ofp ostoperative 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. |
