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Biliary pancreatitis. Operative outcome with a selective approach
W H Schwesinger1, C P Page, K R Sirinek
1Department of Surgery, University of Texas Health Science Center (UTHSC), San Antonio 78284-7842.
Archives of Surgery (Chicago, Ill. : 1960)
|July 1, 1991
Summary
A selective approach to biliary pancreatitis is effective, allowing most patients to undergo elective surgery with low mortality. This strategy reduces unnecessary common duct explorations, as many stones pass spontaneously.
Area of Science:
- Gastroenterology
- Surgical Gastroenterology
- Hepatobiliary Surgery
Background:
- Biliary pancreatitis management requires careful consideration of surgical intervention.
- A selective approach aims to optimize outcomes and resource utilization.
Purpose of the Study:
- To evaluate the efficacy of a selective surgical approach for biliary pancreatitis.
- To assess patient outcomes, including mortality and length of stay, associated with this strategy.
Main Methods:
- Retrospective review of 276 consecutive patients with biliary pancreatitis over a 7-year period.
- Analysis of operative timing (elective vs. urgent) and procedures performed.
- Comparison of outcomes based on initial management strategy.
Main Results:
- 63% of patients underwent elective operations, while 37% required urgent surgery.
- Only 3.6% of patients needed primary pancreatic operations, with half of these being emergencies.
- Common duct surgical explorations decreased significantly when delayed beyond the third hospital day.
- Overall mortality was 1.8%, but increased to 30% for primary pancreatic operations.
Conclusions:
- A selective approach to biliary pancreatitis is associated with a low mortality rate and acceptable hospital stay.
- This strategy facilitates elective surgery in the majority of patients.
- Conservative management allows spontaneous passage of common duct stones, often enabling cholecystectomy alone.