Cholecystectomy without intraoperative cholangiogram in gallstone pancreatitis

To determine the long term outcome of cholecystectomy without intraoperative cholangiogram (IOC) in patients recovering from acute gallstone pancreatitis with normal preoperative liver function tests and imaging.

The medical records of all patients who underwent cholecystectomy without IOC for gallstone pancreatitis at King Saud Medical City, Riyadh, Saudi Arabia between January 2005 and December 2009 were studied retrospectively. Patients with severe pancreatitis and those who had preoperative endoscopic retrograde cholangio-pancreatography (ERCP) were excluded from the study. Data on patients' demography, symptoms, laboratory findings, intraoperative and postoperative findings, length of hospital stay, and outpatient follow up were collected and analyzed.

A total of 160 patients were treated for acute gallstone pancreatitis. Forty-four patients with preoperative ERCP (n = 39), and severe pancreatitis (n = 5), were excluded. The remaining 116 patients initially underwent conservative treatment followed by cholecystectomy without IOC. All were followed up for an average of 2-4 visits. Five patients (4.3%) were re-admitted with gallstone related bilio-pancreatic complications. They underwent ERCP and CBD stone clearance. Four patients were lost to follow up. The remaining 107 patients have remained asymptomatic 12-55 months after cholecystectomy.

The incidence of bilio-pancreatic complications from unsuspected CBD stones in patients of biliary pancreatitis that underwent cholecystectomy without IOC is very low. Therefore, a routine IOC in these patients can be omitted safely.