Outcome of Laparoscopic Cholecystectomy for Presumed Biliary Pancreatitis
Abstracts
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Anatomic and clinical data have long supported the concept of gallstone migration as a cause of acute pancreatitis. Cholecystectomy offers the potential for preventing subsequent episodes of pancreatitis. Calculi of variable size must be excluded to prevent recurrent, potentially highly morbid disease. Cholecystectomy may also represent definitive treatment for idiopathic pancreatitis presumptively due to microlithiasis. A review of patients who underwent laparoscopic cholecystectomy for known calculous or idiopathic pancreatitis to assess the outcome of this intervention. A cholecystectomy data base was querried for patients operated for pancreatitis between July 1995 through June 2000. A total of 94 patients underwent cholecystectomy, 72 operated for calculous biliary etiology based on transcutaneous ultrasound. Twenty-two patients were operated for presumed idiopathic pancreatitis based on a negative ultrasound and history. Patients with known calculi included 42 women and 30 men with a mean age of 62 (range 21-80) years. Preoperative ERCP's were performed in 31 patients (43%) and was diagnostic of common duct stones in 8 (27%). Intraoperative cholangiography was successful in 68 of 72 patients (94%), and common duct stones were found in 10 (15%). Conversion to open was done in three (4%). At a mean follow up of 57 months, pancreatic complications occurred postoperatively in five patients (7%): two with acute pancreatitis, one divisum, one ampullary stricture. Patients with idiopathic pancreatitis presumed to have microlithiasis included 11 women and 11 men with a mean age of 45(range 34 -75) years. Preoperative evaluation included crystal analysis in two patients, ERCP in 9 (41%) and MRCP in two. Conversion to open occurred in two (9%). Unsuspected calculi were discovered by pathology in five (23%), including two with common duct stones at operative cholangiography. At a mean follow-up of 47 months, subsequent biliary pancreatic disease occurred in six (27%): four with chronic pancreatitis, one each with pancreatic divisum and sphincter dysfunction. In summary, laparoscopic cholecystectomy confers long term success in preventing pancreatic complications when calculi are diagnosed preoperatively. Patients with presumed idiopathic pancreatitis should be investigated for ductal abnoramlity with noninvasive testing. Empiric cholecystectomy is advised for patients with idiopathic pancreatitis and a normal pancreatic duct to also achieve high clinical success by removing unsuspected calculi. |
