Comparison of the results of early, delayed and elective surgery in biliary pancreatitis

To evaluate the results of the patients who underwent surgery for biliary pancreatitis, with respect to timing of operation.

192 Patients underwent surgery for biliary pancreatitis between January 1990 and December 1999. The patients were retrospectively separated into three groups: early surgery (within 72 hours after admission), delayed surgery (between 3 and 15 days after admission) and elective surgery (after 15 days).

There were 98 patients in the early surgery group, 46 in the delayed surgery group and 48 in the elective surgery group. The number of Ranson's criteria present was between 3 and 5 in 58.2% of the cases in the early surgery group and in 54.3% of the cases in the delayed surgery group, whereas 62.5% of the cases in the elective surgery group had 0-2. APACHE II score was in the 6-10 range in 43.9% of the cases in the early surgery group and in 39.1% of the cases in the delayed surgery group, whereas 66.7% of the cases in the elective surgery group had between 0 and 5. The most frequent operations in the early and delayed surgery groups was cholecystectomy, common bile duct exploration, and T-tube placement (60.2% and 69.6%, respectively), whereas it were laparoscopic cholecystectomy in the elective surgery group (66.7%). Pancreatitis-related complication rates in the early, delayed and elective surgery groups were 20.4%, 17.4% and 8.3%, respectively. Mortality rates were 5.1% and 4.3% in the early and delayed surgery groups, respectively. There was no deaths in the elective surgery group.

In biliary pancreatitis, surgery should not be considered as a primary option until the resolution of the pancreatic inflammation and its systemic effects. It should be employed only when the clinical picture does not ameliorate in spite of conservative treatment.