Laparoscopic management of acute biliary pancreatitis

The appropriate management of acute biliary pancreatitis has evolved considerably over the past decades. The advent of laparoscopic surgery made it necessary to reevaluate the traditional algorithms.

This study assesses the outcome of 40 patients laparoscopically treated for gallstone pancreatitis. The severity of pancreatitis was scored by clinical and biochemical evaluation and CT findings. Laparoscopic cholecystectomy was performed during the same admission in all cases. In no case was a preoperative endoscopic retrograde cholangiopancreatography (ERCP) performed. In 32 patients (80%) with mild acute pancreatitis interval cholecystectomy was less than 1 week (group A) and in eight patients (20%) with severe disease it was more than 7 days (group B). All patients underwent intraoperative cholangiography.

The rate of common bile duct (CBD) stones was 5% (two cases), both occurring in the group A. There was one perioperative death (2.5%) in group B and one late CBD injury (2.5%) in group A, not requiring surgery. Complication rate was significantly higher in group B (50%) than in group A (9.4%).

We consider that treatment of mild-to-moderate acute biliary pancreatitis can be satisfactorily accomplished by laparoscopy with routine intraoperative cholangiography and laparoscopic treatment of bile duct stones, showing no mortality and low morbidity rate. Laparoscopic treatment of patients with severe acute pancreatitis deserves further investigation.