Biblioteca Virtual en Salud

Background:

Acute gallstone pancreatitis is the common condition marked by pancreatic inflammation. In general, patients with gallstone induced mild pancreatitis should undergo definitive treatment in the form of LC before discharge from hospital, during first admission itself. This is more important to prevent a further attack of acute pancreatitis, seen in as many as 30-50%, during the waiting period of LC. Our study analyzes various parameters in patients which were treated by early and delayed laparoscopic cholecystectomy who presented with mild acute biliary pancreatitis.

Methods:

A prospective study was conducted for one year, where 25 cases were operated early (within 8 days of pain abdomen) and another 25 cases were operated by delayed laparoscopic cholecystectomy for diagnosed mild acute biliary pancreatitis. Various parameters were assessed and compared which included both intra operative and postoperative events. Haemodynamically unstable, associated choledocholithiasis, severe AP and patients with malignancy were excluded from this study.

Results:

Twelve cases presented with recurrent attacks in waiting period which were delayed for surgery. In early group, operative time ranged from 19-40 minutes, operative blood loss about 10-50 ml, 3 patients were converted from LC to OC, 6 patients needed a drain and hospital stay ranged from 2-6 days. In delayed group, operative time ranged from 18-36 minutes, operative blood loss about 10-40 ml, 2 patients converted from LC to OC, 3 patients needed a drain and hospital stay ranged from 1-5 days. Post operative analgesia dose was also comparable.

Conclusion:

In new era of sophisticated technology, improved operative techniques and better post operative management; early LC is gold standard approach in patients with mild to moderate gall stone induced AP. It protects against further attacks of biliary pancreatitis, with no increase in complications or morbidity. Therefore, LC in the early period is safe, effective and feasible in patients of gallstone induced AP, preventing recurrent attacks, which otherwise cause significant morbidity and even mortality in patients.