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Early laparoendoscopic rendezvous for acute biliary pancreatitis: preliminary results
G Borzellino1, F Lombardo, A M Minicozzi
1Department of Surgery, University Hospital of Verona, Verona, Italy. gborz@libero.it
Insights
Urgent laparoscopic cholecystectomy with intraoperative cholangiography and rendezvous effectively manages acute biliary pancreatitis. This approach restores bile duct patency, reducing complications and mortality in early-stage cases.
Area of Science:
- Gastroenterology
- Surgical Innovation
- Biliary Tract Disease
Background:
- Acute biliary pancreatitis is a significant clinical challenge.
- Restoring papillary patency early is hypothesized to improve outcomes.
- The role of urgent surgical intervention requires further evaluation.
Purpose of the Study:
- To assess the efficacy of urgent laparoscopic cholecystectomy in acute biliary pancreatitis.
- To evaluate the utility of intraoperative cholangiography and rendezvous procedures.
- To determine the impact on pancreatitis natural history and patient outcomes.
Main Methods:
- Study included patients in the early stage of acute biliary pancreatitis.
- Urgent laparoscopic cholecystectomy performed within 72 hours for 55 patients (based on ASA score).
- Intraoperative cholangiography, common bile duct flushing, and rendezvous techniques employed as needed.
Main Results:
- All urgent laparoscopic cholecystectomies were completed without conversion.
- Common bile duct stones or spasm identified in 30 patients; patency restored via flushing or rendezvous.
- Low rates of organ failure (1.8%), pancreatic necrosis (1.8%), and overall mortality (1.8%) observed.
Conclusions:
- Urgent laparoscopic cholecystectomy with selective intraoperative rendezvous is a viable treatment option.
- This strategy appears safe and effective for early-stage acute biliary pancreatitis.
- The procedure aids in managing common bile duct issues during pancreatitis treatment.
Introduction:
Early restored patency of the papilla has been hypothesized to reduce complications and mortality of acute biliary pancreatitis. The aim of this study was to evaluate the role of urgent laparoscopic cholecystectomy with intraoperative cholangiography and rendezvous when necessary in acute biliary pancreatitis natural history.
Patients And Methods:
Patients observed in the early stage of an acute biliary pancreatitis were included in the study. Operative risk assessment based on American Society of Anesthesiologists (ASA) score allowed the performance of urgent laparoscopic cholecystectomy within 72 h from onset of symptoms in 55 patients and a delayed intervention during the same admission in 21 patients. Intraoperative cholangiography was performed in all cases, and clearance of common bile duct was performed by flushing when possible, or rendezvous when necessary. Evolution of pancreatitis was evaluated with clinical and radiological monitoring.
Results:
Urgent laparoscopic cholecystectomy was performed in all cases without conversion. At intraoperative cholangiography common bile duct was free in 25 patients, a papillary spasm was observed in 9, and common bile duct stones in 21 patients. Patency of the papilla was restored by flushing in 13 patients, while a rendezvous was necessary in 17 patients. The rate of organ failure and pancreatic necrosis was 1.8%, overall mortality was 1.8%, and overall morbidity 21.8%. No infectious complications of peripancreatic collections were observed.
Conclusion:
Urgent laparoscopic cholecystectomy with selective intraoperative rendezvous may be considered as a treatment option in the early stage of acute biliary pancreatitis.
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