Safety of operation in biliary pancreatitis during the same hospitalization

Over the past 4 years, 61 patients with biliary pancreatitis were managed, 48 of whom had operation on the biliary tree within the same hospital admission. Initial therapy was medical and operation was performed at a median of 6 days from admission (range: 3-14 days). Two patients required surgery for non-resolution of the pancreatitis, but the other 44 patients had clinical and biochemical resolution prior to surgery. At operation, oedematous-interstitial pancreatitis was found in 18 patients, necrotizing pancreatitis in two and a normal pancreas in 28 patients. Common duct exploration in 15 patients resulted in 10 positive explorations. One death occurred in a patient with necrotizing pancreatitis and an impacted stone, but overall morbidity was low and total hospitalization in the operated group averaged 12 days. There was a statistically significant difference in the incidence of bile duct stones (five of 10 versus seven of 38, P = 0.019) and operative findings of pancreatitis (seven of 10 versus 11 of 38, P = 0.038) in patients having surgery before or after 4 days of hospitalization. Initial conservative management for 4 days allows resolution of pancreatitis in most patients, minimizing the need for and potential risk from common duct exploration.