Laparoscopic Cholecystectomy for Gallstones Complicated with Acute Biliary Pancreatitis / 中国微创外科杂志

ABSTRACT

Objective To explore the feasibility and proper time of laparoscopic cholecystectomy(LC)for the treatment of gallstones complicated with acute biliary pancreatitis(ABP).Methods From January 1999 to August 2007,72 patients with gallstones complicated with ABP were treated with LC in our department.Among the patients,early LC was performed on 56 cases when their symptoms of pancreatitis were relieved,elective LC was carried out in 8 patients,while emergent LC was required in the other 8 patients because of failure of conservative treatment.Results The LC was successfully completed in all the cases with a mean operation time of 63 min(30-135 min),and a mean blood loss of 50 ml(20-230 ml).Intraoperative cholangiography was carried out in 5 patients,4 of them were diagnosed as having stones in the lower common bile duct,and were then cured by endoscopic retrograde cholangiopancreatography(ERCP)and endoscopic sphincterotomy(EST)after LC.Only one patient was converted to open surgery.No perioperative death,or postoperative biliary hemorrhage or leakage occurred in this series.After the operation,pathological examinations revealed multiple small or sand-like stones in the resected gallbladders.The patients were followed up for 2 months to 8 years(mean 19 months);during this period,no recurrent pancreatitis or cholelithiasis was found.Conclusions LC is feasible and safe for patients with gallstones complicated with acute pancreatitis at early stage if perioperative treatments has been properly carried out.Preoperative MRCP,intraoperative cholangiography,and postoperative EST are essential auxiliary techniques for the treatment.