Laparoscopic cholecystectomy after pancreatic debridement (original) (raw)
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Post-laparoscopic cholecystectomy pancreatitis
International Surgerry Journal, 2024
Laparoscopic cholecystectomy is one of the commonest operations performed on the biliary system. Acute pancreatitis following Lap-chole is quite uncommon. Whether pancreatitis is a complication or a sequalae to surgical treatment of gall stone disease continues to be a debatable issue. A 37-year-old lady underwent laparoscopic cholecystectomy for incidentally diagnosed gall stones. Early post-operative course was uneventful. The patient presented 3 weeks after surgery with severe excruciating abdominal pain and was diagnosed as acute pancreatitis by ultrasound evaluation. Liver function tests were altered with raised bilirubin, serum lipase and amylase. MRCP revealed a normal biliary tract. Pancreas showed changes of acute interstitial pancreatitis. Patient responded to conservative line of treatment. Acute pancreatitis could be a known complication following laparoscopic cholecystectomy. What causes pancreatitis continues to be a matter for debate. MRCP is the investigation of choice. Interventional endoscopy (ERCP) is indicated in cases of impacted gallstone in the CBD. While if the CBD is clear of stones, aggressive conservative management will suffice.
Influence of timing on performance of laparoscopic cholecystectomy for acute biliary pancreatitis
Tropical gastroenterology : official journal of the Digestive Diseases Foundation
Gallstone disease is the most common cause of acute pancreatitis. Cholecystectomy is mandatory to avoid recurrence of pancreatitis. Our objective was to evaluate the results of laparoscopic cholecystectomy (LC) in patients with gall-stone induced pancreatitis. All patients presenting to us within the time frame from February 2004 to June 2008 with acute biliary pancreatitis were included in the study. The severity of pancreatitis was assessed by Ranson's criteria. ERCP and endoscopic sphincterotomy was performed when the common bile duct (CBD) was dilated (>6 mm) with either calculi or sludge as seen on imaging. Patients with successful ERCP with predicted demanding laparoscopic cholecystectomy were discharged instead for an elective LC, 4-6 weeks later. Patients with mild pancreatitis (with Ranson's score of 3 or less) and predicted uncomplicated LC underwent surgery at the same admission. The difficulty of the procedure was determined by the presence of adhesions in the...
Medical Journal of Clinical Trials & Case Studies
Introduction: Pancreatitis is an inflammatory process in which pancreatic enzymes autodigest the gland. The gland sometimes heals without any impairment of function or any morphologic changes; this process is known as acute pancreatitis. Pancreatitis can also recur intermittently, contributing to the functional and morphologic loss of the gland; recurrent attacks are referred to as chronic pancreatitis. Both forms of pancreatitis may present in the emergency department (ED) with acute clinical findings. Recognizing patients with severe acute pancreatitis as soon as possible is critical for achieving optimal outcomes (see Presentation). Once a working diagnosis of acute pancreatitis is reached, laboratory tests are obtained to support the clinical impression, to help define the etiology, and to look for complications. Diagnostic imaging is unnecessary in most cases but may be obtained when the diagnosis is in doubt, when severe pancreatitis is present, or when a given imaging study might provide specific information needed to answer a clinical question. Image-guided aspiration may be useful. Genetic testing may be considered. Objective: To compare of early vs late cholecystectomy performed for gall stone pancreatitis in terms of mean length of hospital stay Setting: This study was carried out in department of Surgery, Hayatabad Medical Complex, Peshawar. Duration of Study: This study was for 8 months of duration and was carried out after approval of the synopsis. Study Design: Randomized control trial Materials and Methods: This study was conducted in the in the Department of surgery, Hayatabad Medical Complex Peshawar (from 15th September 2014 to 15th May 2015). Through a randomized control Study Design, a total of 60 patients presenting with mild acute pancreatitis were included in the study in a consecutive manner and subjected to early or late cholecystectomy and then the length of hospital stay after the surgery was measured in days. Results: The mean age of the patients of the group 1 was 43.27 years and that of the group 2 was 42.87 years .With regards to gender, there were 22 females and 8 males in group 1 making a percentage of 73.3 and 26.7 respectively. In group 2, 16 patients were females while 14 were males giving a percentage of 53.3 and 46.6 respectively. The mean length of hospital stay for group 1 was 4.63 days and for group 2 was 3.80 days. For females of group 1 the mean length of hospital stay was 4.68 days and for males was 4 days. For the females of group 2, the mean length of hospital stay was 4 days and for males was 3.57 days. Conclusion: Length of hospital stay is longer in early cholecystectomy as compared to late cholecystectomy but is statistically nonsignificant.
Journal of Gastrointestinal Surgery, 2006
Patients with moderately severe gallstone pancreatitis with substantial pancreatic and peripancreatic inflammation, but without organ failure, frequently have an open cholecystectomy to prevent recurrent pancreatitis. In these patients, prophylactic endoscopic retrograde cholangiography (ERC) with endoscopic sphincterotomy (ES) may prevent recurrent pancreatitis, permit laparoscopic cholecystectomy, and decrease risks. The medical records of all patients with pancreatitis undergoing cholecystectomy from 1999-2004 at the University of North Carolina Memorial Hospital were reviewed. Data regarding demographics, clinical course, etiology of pancreatitis, operative and endoscopic interventions, and outcome were extracted. Moderately severe gallstone-induced pancreatitis was defined as pancreatitis without organ failure but with extensive local inflammation. Thirty patients with moderately severe gallstone pancreatitis underwent ERC and ES and were discharged before cholecystectomy. Mean interval between ES and cholecystectomy was 102 6 17 days. Cholecystectomy was performed laparoscopically in 27 (90%) patients, open in three (10%) patients, and converted to open in two (7%) patients, with a morbidity rate of 7% (two patients). No patient required drainage of a pseudocyst or developed recurrent pancreatitis. Interval complications resulted in hospital readmission in seven (23%) patients. In conclusion, recurrent biliary pancreatitis in patients with moderately severe gallstone pancreatitis is nil after ERC and ES. Hospital discharge of these patients permits interval laparoscopic cholecystectomy, but close follow-up is necessary in these potentially ill patients.
Pancreatic surgery in the laparoscopic era
JOP : Journal of the pancreas, 2003
Recent advances in technology and techniques have opened the gates widely to a wide range of applications of minimally invasive surgery in patients with inflammatory and neoplastic diseases of the pancreas. Laparoscopic cholecystectomy is the gold standard treatment for prevention of further attacks of acute biliary pancreatitis. Bile duct calculi detected at intraoperative cholangiography in patients with mild attacks of pancreatitis may be safely managed with laparoscopic bile duct exploration. Laparoscopic internal drainage of large, persistent and symptomatic pancreatic pseudocysts is safely applicable to most patients, achieves adequate drainage and facilitates debridement, and brings recognised benefits over open surgery and endoscopic approaches. Laparoscopic pancreatic necrosectomy for infected necrosis is feasible in some patients but the benefits of this approach in this high-risk group of patients remain to be shown. Staging laparoscopy and laparoscopic ultrasound avoids ...
Early Cholecystectomy for Mild to Moderate Gallstone Pancreatitis Shortens Hospital Stay
Journal of the American College of Surgeons, 2007
BACKGROUND: The timing of cholecystectomy in gallstone pancreatitis remains controversial. We hypothesized that in patients with mild to moderate gallstone pancreatitis (three or fewer Ranson's criteria), performing early cholecystectomy before resolution of laboratory or physical examination abnormalities would result in shorter hospitalization, without adversely affecting outcomes. STUDY DESIGN: An observational study consisting of a retrospective and a prospective group was conducted. For the prospective group, a deliberate policy of early cholecystectomy (less than 48 hours from admission) was used. The primary end point was total length of hospital stay. Secondary endpoints were time from admission to definitive operation, need for endoscopic retrograde cholangiography, and major complications (organ failure and death).
Early laparoscopic cholecystectomy following acute biliary pancreatitis expedites recovery
Turkish Journal of Trauma and Emergency Surgery, 2017
BACKGROUND: In this retrospective study, we aimed to assess the reliability of early cholecystectomy, risk of recurrent biliary pancreatitis, and their effects on hospital length of stay and morbidity by comparing the results of early and late laparoscopic cholecystectomy in patients with acute biliary pancreatitis. METHODS: A total of 131 patients, who were diagnosed with acute biliary pancreatitis at Okmeydanı Education and Research Hospital in January 2009-December 2012, were included in the study. Demographic specifications of patients, duration of their complaints, biochemistry and hemogram values at first arrival, Ranson criteria, number of attacks, screenings, operation type and period, number of days between the first attack and operation, hospital length of stay, and complications were recorded. Patients who underwent cholecystectomy within the first 2 weeks were considered early (group 1) and those who under the operation after 2 weeks were considered late (group 2). RESULTS: There were 47 patients in group 1 and 84 patients in group 2. Open surgery was not performed on any patient, and there was no choledoch injury and mortality. The average hospital length of stay was 7.6±3.0 days in group 1 and 10.7±8.3 days in group 2, with a statistically significant difference between the groups (p=0.006). Two or more number of attacks occurred in 15 patients in group 2 (18%), with a statistically significant difference between the groups (p=0.000). CONCLUSION: Laparoscopic cholecystectomy is safe as it does not increase operation time and morbidity in biliary pancreatitis with a Ranson score of ≤3 or cause difficulty in dissection. Late cholecystectomy causes recurrent attacks and increases the hospital length of stay and treatment costs. Using randomized controlled studies, the effectiveness and reliability of early cholecystectomy in mild and moderate biliary pancreatitis can be verified.
Annals of Surgery, 2004
Background Data: Standard management of gallstoneassociated acute pancreatitis calls for cholecystectomy to be performed during the same hospitalization after acute symptoms have subsided. However, infectious complications are common when cholecystectomy is performed sooner than 3 weeks after severe acute pancreatitis. Fluid collections, common in patients with moderate to severe acute pancreatitis, are additionally problematic. No previous study has examined the role of peripancreatic fluid collections and subsequent pseudocyst in outcomes after cholecystectomy in these patients. Objectives: We compare results of delaying cholecystectomy after moderate to severe acute pancreatitis with early cholecystectomy. Methods: Since 1987, all patients with moderate to severe gallstone-associated acute pancreatitis and associated fluid collections were addressed. Moderate to severe acute pancreatitis was defined as Ͼ 5 Ranson prognostic indicators. Fluid collection was established by computed tomography (CT) scan. Patients were evaluated for duration of hospitalization, complications of cholecystectomy, resolution or persistence of pseudocysts, nonoperative interventions performed on pseudocysts, intercurrent episodes of acute pancreatitis during the monitoring period, episodes of sepsis, and mortality. Results: A total of 187 patients with moderate to severe gallstoneassociated acute pancreatitis survived their acute stage; 151 had peripancreatic fluid collections. Seventy-eight of the 187 had early cholecystectomy, 62 of whom had fluid collections; 109 were monitored before cholecystectomy, 89 of whom had fluid collections. Fluid collections resolved without intervention in 36 (40%) of 89 in the monitored group and in 13 (21%) of 62 in the early cholecystectomy group. Percutaneous drainage was performed in 16 (18%) of 89 in the monitored group and in 31 (50%) of 62 in the early cholecystectomy group. Sepsis occurred in 6 (7%) of 89 in the monitored group and 29 (47%) of 62 in the early cholecystectomy group. Complications of cholecystectomy occurred in 6 (5.5%) of 109 of the monitored patients and in 34 (44%) of 78 in the early cholecystectomy group. Fifty-three patients in the monitored group and 49 patients in the early cholecystectomy group required operative pseudocyst-enterostomy. This procedure was combined with cholecystectomy in the monitored patients. Mean hospitalization was longer in the early operation group. Conclusion: Cholecystectomy should be delayed in patients who survive an episode of moderate to severe acute biliary pancreatitis and demonstrate peripancreatic fluid collections or pseudocysts until the pseudocysts either resolve or persist beyond 6 weeks, at which time pseudocyst drainage can safely be combined with cholecystectomy.