Acute biliary pancreatitis: staging and management.

Area of Science:

• Gastroenterology
• Surgical Gastroenterology
• Hepatobiliary Surgery

Background:

• Acute biliary pancreatitis presents significant morbidity (15-50%) and mortality (20-35%).
• Approximately 75% of idiopathic acute pancreatitis cases are biliary in origin, underscoring the importance of early diagnosis and treatment.
• Timely diagnosis is critical for effective management of acute biliary pancreatitis.

Purpose of the Study:

• To evaluate the efficacy of minimally invasive surgical strategies for acute biliary pancreatitis.
• To compare outcomes between severe and mild cases of acute biliary pancreatitis treated surgically.
• To establish optimal timing for surgical intervention in acute biliary pancreatitis.

Main Methods:

• Diagnosis in 78 patients involved clinical assessment, ultrasonography (76.9%), and laboratory tests (23.1%).
• Severity was assessed using Ranson and APACHE II scores, classifying patients into severe (30.7%) and mild (69.2%) groups.
• Severe cases underwent emergency ERCP + ES (24-48 hrs) followed by laparoscopic cholecystectomy (10 days); mild cases had laparoscopic cholecystectomy + intraoperative cholangiography (within 10 days).

Main Results:

• Endoscopic retrograde cholangiopancreatography (ERCP) with endoscopic sphincterotomy (ES) was curative in 19 severe cases.
• Laparoscopic cholecystectomy in mild cases had a low morbidity rate (7.3%).
• Common bile duct stones were identified in 31.4% of mild and 75% of severe cases via intraoperative cholangiography.

Conclusions:

• Surgical treatment is essential for acute biliary pancreatitis, with minimally invasive procedures preferred.
• Prompt surgical intervention (ERCP + ES within 24-48 hrs for severe, LC within 10 days for mild) optimizes outcomes.
• Minimally invasive approaches significantly reduce morbidity and mortality in acute biliary pancreatitis management.