[Acute biliary pancreatitis: mini-invasive treatment]

Area of Science:

• Gastroenterology
• Surgical Gastroenterology
• Hepatobiliary Surgery

Background:

• Acute biliary pancreatitis (ABP) presents significant morbidity (15-50%) and mortality (20-35%).
• Accurate etiological assessment and severity grading are crucial for effective treatment planning.
• Approximately 50% of idiopathic pancreatitis cases are actually biliary in origin.

Purpose of the Study:

• To evaluate the efficacy of surgical management strategies for acute biliary pancreatitis.
• To determine optimal timing and procedural choices for severe versus mild ABP.
• To assess the role of endoscopic retrograde cholangiopancreatography with sphincterotomy (ERCP + ES) and laparoscopic cholecystectomy (LC) in ABP management.

Main Methods:

• Forty-nine ABP patients were diagnosed using ultrasound or laboratory findings.
• Severity was assessed using Ranson and APACHE II scoring systems.
• Treatment involved emergency ERCP + ES followed by LC for severe cases (within 24-48 hours), and LC within 10 days for mild cases, often with intraoperative cholangiography (IOC).

Main Results:

• Severe ABP (30.6%) showed high rates of biliary stones (80%) and required emergency ERCP + ES and early LC.
• Mild ABP (69.3%) had lower morbidity (8.8%) with successful LC and IOC revealing stones in 32.5% of cases.
• Emergency ERCP + ES was effective in 11 severe cases; laparotomy for necrosis had 75% mortality.

Conclusions:

• Surgical intervention is the definitive treatment for ABP.
• Minimally invasive approaches, including ERCP + ES and LC, are highly effective for both severe and mild ABP when performed within recommended timeframes.
• Early intervention with ERCP + ES and LC in severe ABP, and LC with IOC in mild ABP, leads to favorable outcomes.