Abstract
Acute gallstone pancreatitis has traditionally been managed by early cholecystectomy with intraoperative cholangiography (IOC). To evaluate the effect of IOC on patient outcome, we analyzed all patients operated on for acute gallstone pancreatitis at our institution over a 3-year period. A total of 200 patients (37 open, 163 laparoscopic) were evaluated. Nineteen of 34 patients who underwent preoperative endoscopic retrograde cholangiopancreatography (ERCP) were found to have common bile duct (CBD) stones. The 59 patients who underwent cholecystectomy with IOC had significantly longer operative times compared to the 141 patients who underwent cholecystectomy alone (167 vs. 105 minutes for open [P= 0.008] and 89 vs. 68 minutes for laparoscopic [P< 0.0001] operations). Of the 59 patients who underwent IOC, only nine (15%) had abnormal cholangiograms, and CBD exploration in seven revealed stones in four patients, edematous ampullae in two, and no abnormality in one. Six of eight patients (5 IOC, 3 no IOC) who required immediate postoperative ERCP were noted to have CBD stones. Patients who underwent IOC had significantly longer postoperative hospital stays (3.8 vs. 2.0 days [P= 0.007]). The incidence of retained CBD stones following surgery was similar (5.1% IOC, 2.8% no IOC). Although 7 of 122 patients who underwent laparoscopic cholecystectomy without IOC were readmitted, only one was found on ERCP to have a retained CBD stone. Age, sex, preoperative days, procedure type, and biliary-pancreatic complications after discharge did not differ significantly between patients with and without IOC. We conclude that IOC in patients operated on for acute gallstone pancreatitis results in a longer operative time and a prolonged postoperative course, but has no effect on the incidence of retained CBD stones.
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References
Steinberg W,Tenner S. Acute pancreatitis. N Engl J Med 1994;330:1198–1210.
Fan S-T,Lai ECS,Mok FPT,Lo CM,Zheng SS,Wong J. Early treatment of acute biliary pancreatitis by endoscopic papillotomy. N Engl J Med 1993;328:228–232.
Folsch UR,Nitsche R,Ledtke R,Hilgers RA,Creutzfeldt W. Early ERCP and papillotomy compared with conservative treatment for acute biliary pancreatitis. N Engl J Med 1997;336:237–242.
Chang L,Lo SK,Stabile BE,Lewis RJ,de Virgilio C. Gallstone pancreatitis: A prospective study of the incidence of cholangitis and clinical predictors of retained common bile duct stones. Am Gastroenterol 1998;93:527–531.
Soetikno RM,Carr-Locke DL. Endoscopic management of acute gallstone pancreatitis. Gastrointest Endosc Clin North Am1998;8:1–12.
Schwesinger WH,Page CP,Gross GWW,Miller JE,Strodel WE,Sirinek KR. Biliary pancreatitis. The era of laparoscopic cholecystectomy. Arch Surg 1998;133:1103–1106.
Korman J,Cosgrove J,Furman M,Nathan I,Cohen J. The role of endoscopic retrograde cholangiopancreatography and cholangiography in the laparoscopic era. Ann Surg 1996;223:212–216.
Reber HA. Pancreas. In Schwartz SI, Shires GT, Spencer FC, Daly JM, Fischer JE, Galloway AC, eds. Principles of Surgery, 7th ed. New York: McGraw-Hill, 1999, 1467–1499.
Srinathan SK,Barkun JS,Mehta SN,Meakins JL,Barkun AN. Evolving management of mild-to-moderate gallstone pancreatitis. J GASTROINTEST Surg 1998;2:385–390.
Tang E,Stain SC,Tang G,Froes E,Berne TJ. Timing of laparoscopic surgery in gallstone pancreatitis. Arch Surg 1995;130:496–500.
Bulkin AJ,Tebyani N,Dorazio RA. Gallstone pancreatitis in the era of laparoscopic cholecystectomy. Am Surg 1997; 63:900–903.
Schwesinger WH,Page CP,Sirinek KR,Levine BA,Aust JB. Biliary pancreatitis: Operative outcome with a selective approach. Arch Surg 1991;126:836–840.
Leitman IM,Fisher ML,McKinley MJ,Rothman R,Ward RJ,Reiner DS,Tortolani AJ. The evaluation and management of known or suspected stones of the common bile duct in the era of minimal access surgery. Surg Obstet Gynecol 1993;176:527–533.
Bergamaschi R,Tuech JJ,Braconier L,Walsoe HK,Marvik R,Boyet J,Arnand JP. Selective endoscopic retrograde cholangiography prior to laparoscopic cholecystectomy for gallstones. Am J Surg 1999;178:46–49.
Lin G,Halevy A,Girtler O. The role of endoscopic retrograde cholangiopancreatography in management of patients recovering from acute biliary pancreatitis in the laparoscopic era. SurgEndosc 1997;11:371–375.
Thompson JE,Bennion RS. Intraoperative endoscopy of the biliary tract. SurgEndosc 1988;2:172–175.
Vechio R,MacFadyen BV,Latteri S. Laparoscopic cholecystectomy: An analysis on 114,005 cases of United States series. Int Surg 1998;83:215–219.
Clark A,Hawes RH,Cooper GS,Hoffman B,Catalano MF,Wong RC,Herbener TE,Sivak MVJr. Prospective assessment of the utility of EUS in the evaluation of gallstone pancreatitis. Gastrointest Endosc 1999;49:599–604.
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Bennion, R.S., Wyatt, L.E. & Thompson, J.E. Effect of intraoperative cholangiography during cholecystectomy on outcome after gallstone pancreatitis. J Gastrointest Surg 6, 575–581 (2002). https://doi.org/10.1016/S1091-255X(01)00017-8
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DOI: https://doi.org/10.1016/S1091-255X(01)00017-8