Optimal type and timing for cholecystectomy in patients with acute biliary pancreatitis

Abstract

Pharmacological management in patients with acute biliary pancreatitis could result in elevated number of its complications. The type of surgery, endoscopical management and timing for these procedures is controversial. For the present study 62 patients with acute biliary pancreatitis were selected. The diagnosis was confirmed by laboratory (blood and urine amylase level) and paraclinic (USG, ERCP with papillosphyncterotomy) tests. In all cases elevated level of urine amylase was detected and in 32.3% - elevated blood bilirubin level. In all patients with signs of elevated pressure in the biliary tree - ERCP with papillosphyncterotomy was performed. In 26(42%) choledocholithiasis was diagnosed while in 36(58%) - other reasons of biliary tract obstruction. In case of choledocholithiasis and patients’ positive evolution, confirmed by instrumental and laboratory tests, ERCP and papillosphyncterotomy was performed within 24-48 h. form admission. These patients underwent surgery within 6-7 days, after general condition improvement - confirmed by laboratory tests. Laparoscopic cholecystectomy was performed in 60, while traditional surgery - in 2 cases. Laparoscopic cholecystectomy in patients with acute biliary pancreatitis can be performed after biliary tree decompression by means of ERCP with papillosphyncterotomy and improvement in patients’ general condition. Laparoscopic cholecystectomy is considered “golden standard” for the treatment of acute biliary pancreatitis.