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The role of intraoperative cholangiogram in the management of patients recovering from acute biliary pancreatitis

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Abstract

Background

Use of the standard management for gallstone-associated acute pancreatitis calls for cholecystectomy with cholangiography performed during the same hospitalization after acute symptoms has decreased. No previous studies, however, have objectively addressed the usefulness of intraoperative cholangiography (IOC) for the management of this condition. This study aimed to determine the incidence of common bile duct (CBD) stones after an acute episode of gallstone pancreatitis.

Methods

The medical records of all patients who underwent a cholecystectomy and IOC after an episode of gallstone pancreatitis during the same admission between 1999 and 2004 at the University of Alberta and Royal Alexandra hospitals were examined to determine the incidence of CBD stones after resolution of gallstone pancreatitis.

Results

After a chart review for a series of 86 patients, 63 met the inclusion criteria. All except for one patient had undergone successful IOC (98%). Among the patients who had no evidence of CBD obstruction on preoperative imaging or lab work, three were found to have a filling defect on IOC and stones on their postoperative endoscopic retrograde cholangiopancreatography (ERCP) (3/63, 5%). This is not significantly different from the 4.6% incidence of CBD stones among patients with cholelithiasis who had normal preoperative imaging and blood work.

Conclusion

In the setting of normal preoperative imaging and lab work, the incidence of CBD stones among patients recovering from acute mild to moderate gallstone pancreatitis is not significantly higher than among patients with no history of pancreatitis. Therefore, an IOC for post-gallstone pancreatitis does not alter management.

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Acknowledgments

The authors thank Mark Wolters for expert assistance with statistical analysis.

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Authors and Affiliations

  1. Centre for the Advancement of Minimally Invasive Surgery, University of Alberta, 205 Tawa Centre, 3017-66 Street, Edmonton, AB, Canada, T6K 4B2

    H. Shayan, D. Kopac & C. B. Sample

Authors
  1. H. Shayan
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  2. D. Kopac
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  3. C. B. Sample
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Corresponding author

Correspondence to C. B. Sample.

Additional information

Presented in oral form at the Canadian Surgery Forum, Montreal, Quebec, September 2005

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Shayan, H., Kopac, D. & Sample, C.B. The role of intraoperative cholangiogram in the management of patients recovering from acute biliary pancreatitis. Surg Endosc 21, 1549–1552 (2007). https://doi.org/10.1007/s00464-006-9169-5

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  • DOI: https://doi.org/10.1007/s00464-006-9169-5

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