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[Acute gallstone pancreatitis--when should the clearance of biliary tract be performed?]
Tormod Bjerkeset1, Knut Skreden, Tom-Harald Edna
1Kirurgisk Avdeling Sykehuset Levanger 7600 Levanger. tormod.bjerkeset@innherred-sykehus.no
Background:
On the basis of a 19-year material we discuss early or delayed surgery for definitive clearance of the biliary tract after acute gallstone pancreatitis.
Material And Methods:
During 1980-98, 218 patients, 133 women and 85 men, median age 69.5 years (16-96 years) with acute gallstone pancreatitis were treated at Levanger hospital, Norway. During 1980-89 (period 1), 111 patients were mainly treated by open operations as soon as the acute pancreatitis had settled, while during 1990-98 (period 2), 107 patients were mainly treated conservatively and the biliary operations performed laparoscopically/endoscopically later.
Results:
In period 1 two patients died, one of them after open surgery (2%). In period 2 four patients died. 21 patients were readmitted due to a new attack, two of whom died. Two patients developed acute cholecystitis.
Interpretation:
Early surgery for the gallstone disease in patients with acute gallstone pancreatitis is well tolerated, recurrent attacks are rare and the mortality low.