[Biliary pancreatitis: when is surgery indicated?]

Retrospective analysis of a homogeneous group of 48 patients admitted with acute pancreatitis of biliary origin showed that 60% were in a serious condition. A total of 41 patients were operated upon, 25 in the early stages, 13 within a month, and 3 at some time after the acute episode. Lithiasis of the common bile duct was detected in 48, 23 and 33% of cases respectively; 9 calculi were enclaved including 7 in the early operated group. Cholecystectomy was combined with external drainage in 24 cases, choledocho-duodenal anastomosis in 3 and sphincterectomy in one; surgery to pancreas was necessary 17 times (necrosectomy in 13 and pancreatectomy in 4). 3 patients received endoscopic treatment and 4 were not operated upon. Ten patients died, including 8 in the early operated group. A literature review suggests that operation should be deferred (10th day), reducing severity of immediate surgery and avoiding risk of short or long term recurrence. The place of endoscopic sphincterectomy, notably in severe forms, has not been established.