Laparoscopic treatment of acute biliary pancreatitis

Laparoscopic cholecystectomy (LC) has become the standard treatment of gallstones. Application of LC in certain complications of biliary stones such as acute biliary pancreatitis (ABP) is not well defined. 10-30% of patients with ABP present associated bile duct stones, and the realization of a preoperative ERCP has been routinely proposed. Nevertheless, this examination may be unnecessary in most patients.

To investigate the applicability of laparoscopic surgery for treatment of ABP.

Between Jan-1992 and June-1995, 368 patients were prospectively evaluated for LC, 274 for indications other than ABP. (Group I, LC) and 91 as a consequence of ABP. (Group II, ABPxL). ERCP was indicated when ultrasonography showed a dilated bile duct (> 8 mm) or when the liver function test (LFT) presented high scores. Age, sex, operative time, incidence of bile duct stones, postoperative stay and morbimortality were evaluated.

The two groups were well matched for age, sex and associated medical risk factors. There were no differences in the operative time, conversion rate or postoperative morbidity (10% vs 10%). ERCP was performed in 25 patients in Group II and bile duct stones were found in 12 cases. In all cases an intraoperative cholangiography was performed, and in 6 patients, bile duct stones were removed by laparoscopic means. Three patients were converted to open surgery on finding duct stones which could not be treated by laparoscopic means. Mean postoperative stay was significantly longer in Group II than in Group I. In two cases, pancreatic pseudocyst was attempted with a laparoscopic approach.

Definitive treatment of ABP could be accomplished effectively by laparoscopy, with selective indication of ERCP.