Results of laparoscopic cholecystectomy for the treatment of gallstone pancreatitis.

PURPOSE: To assess the efficacy of laparoscopic cholecystectomy for the treatment of acute gallstone pancreatitis.

METHODS: The charts of patients who underwent laparoscopic cholecystectomy between July 1990 and March 1993 were reviewed. Data gleaned included age, duration of symptoms, physical exam, laboratory analysis, imaging studies, and postoperative course.

RESULTS: The diagnosis of gallstone pancreatitis was present in 29 of 510 patients (5.7%). The 20 females and nine males ranged in age from 13 to 81 years with an average of 47 years. Twenty-six patients exhibited three or fewer of Ranson's criteria, and three had four criteria. All 29 patients underwent laparoscopic cholecystectomy without complications. Endoscopic retrograde cholangiogram (ERC) was done before operation in four patients, all normal studies. Laparoscopic cholangiography was successful in 18 of the 22 patients in whom it was attempted. Common bile duct (CBD) stones were identified in three patients. Two had all stones cleared via the transcystic approach. The other had several stones removed from the CBD, but some stones were left in the hepatic duct. Postoperative ERC removed the remaining stones. Twenty-two of the 29 (76%) patients were discharged within 2 days of the operation, six were home by Day 6, and the last patient was discharged on Day 16. Twenty-six patients were well in follow-up. Two patients returned 1 month after operation with an elevated serum amylase and lipase that promptly resolved. One patient was lost to follow-up.

CONCLUSIONS: Laparoscopic cholecystectomy is effective for patients with acute gallstone pancreatitis and can be accomplished safely. Laparoscopic cholangiography can be performed, can visualize the anatomy, and can address common bile duct stones. In most cases these patients can be successfully managed without ERC.