Laparoscopic management of gallstone pancreatitis

Thirty-seven patients with gallstone pancreatitis were encountered over a 28-month period from June 1990 to October 1992. The use of laparoscopic cholecystectomy with intraoperative cholangiography in the management of gallstone pancreatitis was retrospectively studied. Thirty-two women and 5 men ranged in age from 16 to 74 years. Admitting amylase levels ranged from 241 to 5547 IU/L. No patient had a clinical history consistent with other causes of pancreatitis. Initial treatment consisted of bowel rest until amylase levels had normalized and abdominal tenderness had resolved. Twenty-nine of 37 patients were initially treated laparoscopically, but 7 required conversion to open cholecystectomy. Choledocholithiasis was identified intraoperatively in 4 patients. These stones were cleared either laparoscopically (2), by open common bile duct exploration (1), or by postoperative endoscopic retrograde cholangiopancreatography (1). Patients treated laparoscopically had a median postoperative discharge time of 1.0 day vs 3.5 days for those treated by open technique. Not all patients with gallstone pancreatitis can be treated successfully using laparoscopic techniques. As the experience and confidence of surgeons increases, laparoscopic management of gallstone pancreatitis is appropriate, with open conversion as necessary.