Gallstone pancreatitis and laparoscopic cholecystectomy

Laparoscopic cholecystectomy is now considered the gold-standard for the treatment of gallbladder stones (NH Consensus Conference 1992). Moreover, its feasibility in complex problems like acute cholecystitis, common bile duct stones and biliary pancreatitis is more widely recognized. The aim of this paper is to evaluate the efficacy of the laparoscopic treatment in acute biliary pancreatitis comparing it with the traditional open surgery. Since February 1991 to January 1995 we treated 18 patients submitted with a diagnosis of acute biliary pancreatitis. In 15 patients the pancreatitis was interstitial while 3 had necrotic pancreatitis. All patients, except 2, were submitted to a laparoscopic cholecystectomy during the same admission, with a mean interval of 11 days from the day of admission to surgery. The other 2 cases, who suffered a severe necrotic pancreatitis, were operated after 3 months. Endoscopic retrograde-cholangiopancreatography (ERCP) was performed in 8 cases (38.8%), with 7 papillosphincterotomy (PST) and stone extraction. In only one case it was necessary to convert to open surgery. The mean operation time was 55 minutes. One patient died due to cardiorespiratory failure 16 days after surgery (death rate: 5.5%). Complications were not observed in the other patients. Our results are similar to those observed in the literature showing that the majority of the patients with biliary pancreatitis can be submitted to laparoscopic surgery with advantage. In case of common bile duct stones, we prefer to perform an ERCP with PST if necessary. We did not observe complications with this strategy but it is probably that in the future the laparoscopic approach will be applied for both gallbladder and CBD stones. At the moment this is reserved to the more experienced surgeons and specialized centers.