Timing of laparoscopic surgery in gallstone pancreatitis

E Tang, S C Stain, G Tang, E Froes, T V Berne
Archives of Surgery 1995, 130 (5): 496-9; discussion 499-500

OBJECTIVE: To study the effect of the timing of laparoscopic cholecystectomy following acute gallstone pancreatitis.

SETTING: University-based county teaching hospital.

DESIGN: Retrospective case series.

PATIENTS: One hundred forty-two patients with gallstone pancreatitis treated by laparoscopic cholecystectomy between April 1991 and September 1993. There were 16 men and 126 women, with a mean age of 39.5 years. The mean serum amylase level at admission was 1616 U/L. All patients were operated on more than 48 hours after admission, after clinical and biochemical resolution of pancreatitis. Preoperative endoscopic retrograde cholangiopancreatography was performed in 25 patients (more than 48 hours after admission), with common bile duct stones being identified and removed in 10.

RESULTS: Twenty patients had three or more Ranson's criteria. Of these, nine had laparoscopic cholecystectomy attempted within the first week of admission. Six (67%) of these patients required conversion to open procedures (two for common bile duct exploration, one for repair of a common hepatic duct injury, and three for anatomic distortion due to inflammation). The mean postoperative stay of the nine patients was 5.4 days. The other 11 patients with three or more Ranson's criteria were operated on after 1 week, and only two required conversion to open cholecystectomy (18%). The mean postoperative stay in these 11 patients was 2.3 days. The difference in conversion rate approached but did not reach statistical significance (P = .08). The postoperative stay, however, was significantly shorter in the group of patients who underwent late operations (P = .03). There were 122 patients with fewer than three Ranson's criteria. In this group, there was no difference in length of postoperative stay between patients operated on earlier and those operated on later (2.4 vs 3.9 days; P = .49; n = 74 and n = 48, respectively). Of these 122 procedures, eight were converted to open procedures (6.6%). There was no significant difference in conversion rates in these patients regardless of whether they were operated on earlier or later.

CONCLUSIONS: Based on these data, we believe, first, that laparoscopic cholecystectomy is safe in patients recovering from gallstone pancreatitis (mortality rate, 0%; bile duct injury, 0.7%). Furthermore, early operation can safely be recommended in patients with mild pancreatitis. However, in patients with three or more Ranson's criteria, operation during the first week following admission is associated with an increase in operative complications, an increased rate of conversion, and longer postoperative stays.

Full Text Links

Find Full Text Links for this Article


You are not logged in. Sign Up or Log In to join the discussion.

Related Papers

Remove bar
Read by QxMD icon Read

Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"