1 research outputs found
Interval Laparoscopic Cholecystectomy in the Management of Acute Biliary Pancreatitis
The timing of laparoscopic cholecystectomy following
an attack of acute biliary pancreatitis is controversial.
The traditional approach of interval
cholecystectomy has been challenged recently. The
present study was designed to evaluate the benefits
of interval laparoscopic cholecystectomy for patients
with mild acute pancreatitis (Ranson less than 3).
Nineteen patients with mild pancreatitis underwent
ultrasonographic evaluation to confirm the biliary
etiology. ERCP was performed in all patients on the
first available endoscopy list, and endoscopic sphincterotomy
was performed in two patients with calculi
or dilated common bile duct on ultrasonographic
examination. Medical treatment was administered
and laparoscopic cholecystectomy was scheduled
after 8β12 weeks to allow the inflammatory process
to settle. There were no recurrent attacks of pancreatitis
during this period. The degree of difficulty of
the laparoscopic procedure was assessed by the presence
of adhesions to the gallbladder area, difficulty
of dissection in the Calot's triangle, intraoperative
bleeding and the need for a drain. Six patients
(31.5%) had severe adhesions, difficult dissection of
the cystic duct and artery, bleeding and prolonged
operating time. In two of these patients (10.5%) the
procedure was converted to open cholecystectomy.
In conclusion, our results suggest that postponing
laparoscopic cholecystectomy in acute pancreatitis
patients is not advantageous surgically and does
not justify the risk of further morbidity caused by
the gallbladder disease