Diagnostic evaluation prior to cholecystectomy in mild-moderate acute biliary pancreatitis (original) (raw)
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World Journal of Surgery, 2003
Biliary stones are the leading cause of acute pancreatitis. Although cholecystectomy and selective endoscopic retrograde cholangiography (ERC) comprise the current treatment in patients with acute biliary pancreatitis (ABP), the time of intervention is still controversial. In this study we evaluated the outcomes of cholecystectomy on first admission for ABP and in patients with recurrent biliary pancreatitis. A series of 43 patients with ABP between January 1997 and November 2000 were evaluated retrospectively. Patients were classified into two groups. Group I included 27 patients who underwent cholecystectomy on first admission before discharge from the hospital. Group II comprised 16 patients who had recurrent biliary pancreatitis and then underwent cholecystectomy. The severity of the pancreatitis was determined by Ranson's criteria. Age, gender, length of hospital stay, severity of pancreatitis, amylase level, and complications of cholecystectomy were evaluated in both groups. Patients in group I underwent cholecystectomy during the original hospital admission and patients in group II during an admission for a recurrence. There were 24 patients with a Ranson's score ≤ 3 in group I and 12 in group II. The mean hospital stays were 15.29 days (range 4-48 days) and 36.66 days (range 15-123 days) in groups I and II, respectively (p = 0.006). Morbidity was 11% without mortality in group I and 43% with one mortality in group II (p = 0.023). Definitive treatment of ABP can be accomplished effectively and safely by cholecystectomy following clinical improvement, with selective ERC performed during the first admission (delayed cholecystectomy). Waiting to perform cholecystectomy (interval cholecystectomy) may result in recurrent biliary pancreatitis, which may increase morbidity and the length of the hospital stay.
Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University
Objective: The objective is to determine the adequacy of early cholecystectomy (EC) versus interval cholecystectomy (IC) in terms of recurrence, duration of hospital admission, and perioperative complications after mild acute biliary pancreatitis (MABP). Methodology: After endorsement from the ethical committee, clinical data and files of all the admitted patients having MABP in the general surgery department of Holy Family Hospital, Rawalpindi, was collected retrospectively from August 2017 to July 2020. The patients’ demographic profile, clinical findings, diagnostic investigations, timing of cholecystectomy, operating surgeons, operative time, biliary complications, intraoperative bleeding, conversion rate, duration of admission, and recurrence were reviewed. Patients presented with abdominal pain, vomiting, jaundice, or fever. The diagnosis was confirmed on the basis of a CT scan of the abdomen showing an inflamed pancreas and stones in the gallbladder. Outcomes were compared an...
Conservative management of cholestasis with and without fever in acute biliary pancreatitis
The presence of cholestasis in both mild and severe forms of acute biliary pancreatitis (ABP) does not justify, of itself, early endoscopic retrograde cholangiography (ERC) or endoscopic sphincterotomy (ES). Clinical support treatment of acute pancreatitis for one to two weeks is usually accompanied by regression of pancreatic edema, of cholestasis and by stone migration to the duodenum in 60%-88% of cases. On the other hand, in cases with both cholestasis and fever, a condition usually characterized as ABP associated with cholangitis, early ES is normally indicated. However, in daily clinical practice, it is practically impossible to guarantee the coexistence of cholangitis and mild or severe acute pancreatitis. Pain, fever and cholestasis, as well as mental confusion and hypotension, may be attributed to inflammatory and necrotic events related to ABP. Under these circumstances, evaluation of the bile duct by endo-ultrasonography (EUS) or magnetic resonance cholangiography (MRC) before performing ERC and ES seems reasonable. Thus, it is necessary to assess the effects of the association between early and opportune access to the treatment of local and systemic inflammatory/infectious effects of ABP with cholestasis and fever, and to characterize the possible scenarios and the subsequent approaches to the common bile duct, directed by less invasive examinations such as MRC or EUS.
Background: Standard recommendations for patients recovering from an episode of biliary pancreatitis include cholecystectomy with intra operative cholangiogram or ERCP during the same hospital admission as it is believed that the instigating factor is the passage of stones through the common bile duct. As ERCP is not widely available and expensive, cholecystectomy with IOC is routinely performed to rule out choledocholithiasis. However detection of common bile duct stones is challenging. Whether these patients undergoing cholecystectomy require direct common bile duct evaluation is controversial. Objectives: To see the presence of common bile duct stones in patients with resolving acute mild biliary pancreatitis. Materials and Methods: Patients admitted in the surgical ward in Patan and Bir hospital with the diagnosis of mild acute biliary pancreatitis that underwent cholecystectomy with intra operative cholangiography from August 2010 to July 2011 were studied. The outcome of cholangiogram was analyzed together with findings of Common bile duct exploration. Result and Conclusion: A total of 52 patients with acute mild biliary pancreatitis were operated during this period. The Common bile duct stone was found in 1.9%. Out of four patients with abnormal cholangiogram, only one patient (25%) had stone on exploration, rest of the three cases (75%) had negative exploration. The presence of common bile duct stone in case of mild acute biliary pancreatitis undergoing cholecystectomy is very low (1.96%), and thus policy of selective IOC should be applied for cases with mild biliary pancreatitis.
International Surgery Journal
Background: Objective of the study was to compare the outcomes of early versus late cholecystectomy in mild to moderate acute biliary pancreatitis.Methods: This comparative prospective study was conducted at Surgical Department of Qazi Hussain Ahmed Medical Complex, Nowshera from 1st January 2018 to 31st March 2020. Patients with mild to moderate acute biliary pancreatitis (ABP) were included in the study. Patients were divided into two groups. Group 1 having patients undergoing early (operated in 7 days) and Group 2 having patients with delayed (operated after 6 weeks) laparoscopic cholecystectomy. The outcomes like hospital stay, peri and post-operative complications, recurrent cholecystitis and pancreatitis were compared. P<0.05 was considered significant.Results: A total of 300 patients were included with 150 in each group. There were 70 (46.66%) males in group 1 while group 2 consisted of 68 (45.33%) males. The median time interval of operation to the laparoscopic surgery wa...
International Surgery Journal
Background: In patients with acute biliary pancreatitis, cholecystectomy is mandatory to prevent further biliary events, but the precise timing of cholecystectomy for mild to moderate disease remain a subject of ongoing debate. The aim of this study is to assess the outcomes of early versus delayed cholecystectomy. We hypothesize that early cholecystectomy as compared to delayed cholecystectomy reduces recurrent biliary events without a higher peri-operative complication rate.Methods: Patients with mild to moderate ABP were prospectively randomized to either an early cholecystectomy versus a delayed cholecystectomy group. Recurrent biliary events, peri-operative complications, conversion rate, length of surgery and total hospital length of stay between the two groups were evaluated.Results: A total of 70 patients were enrolled at tertiary care hospital in central India. Of them, 35were randomized to the early group and 35 patients to the delayed group using simple randomization tech...
2022
Background Although current guidelines recommend cholecystectomy during the same admission in patients with mild acute biliary pancreatitis (ABP), it involves a waiting list most of the time. Aim We aimed to assess the risk of gallstone-related biliary events (GRBEs) such as cholecystitis, cholangitis, and pancreatitis during the waiting period for cholecystectomy and determine predictors of complications after the first episode of ABP. Methods A prospective observational study was conducted at a tertiary hospital for six months in patients with mild ABP. Follow-ups were done by phone calls or using electronic health records for a maximum of 6 months after discharge or until cholecystectomy. Results A total of 194 patients were included in the study. Although all patients were referred to surgeons, only 81 (41.8%) underwent cholecystectomy within 6 months after discharge. During the observation period, GRBEs developed in 68 (35.1%) patients which included biliary colic, recurrent AB...