Early surgery for biliary pancreatitis (original) (raw)

1984, The American Journal of Surgery

Although it is accepted that surgical correction of biliary tract disease is indicated in patients with pancreatitis associated with biliary tract calculi, the appropriate timing of the surgical procedure is controversial, particularly with regard to early surgery (within 48 hours of hospital admission) in patients with more severe forms of pancreatitis. With ultrasonography and hepatobiliary scanning techniques, the diagnosis of biliary tract stone disease can be made accurately, quickly, and relatively noninvasively. Using these methods, we have performed definitive biliary tract surgery on patients with biliary pancreatitis (biliary calculi and elevated amylase levels) as soon as the diagnosis has been made and within 24 hours after admission. This report documents our successful experience with early surgery on 34 patients. Material and Methods From January 1981 to March 1984, all patients seeking treatment for symptoms and signs compatible with biliary colic or acute cholecystitis were admitted to the hospital for evaluation (11. All patients had combinations of nausea, vomiting, and right upper quadrant pain, and all exhibited right upper quadrant tenderness. Initial therapy consisted of nasogastric suction, intravenous fluids, anticholinergic drugs, and intravenous antibiotics in patients with temperatures exceeding 101°F. Values for serum bilirubin, amylase, alkaline phoephatase, prothrombin time, partial thromboplastin time, and electrolytes were determined, and a complete blood count, urinalysis, urine amylase determination, electrocardiogram (for patient-v older than 40 years or as necessary), and chest and abdominal radiographic examinations were performed. As soon as feasible after admission (within 24 hours), gallbladder ultrasonography and hepatobiliary (PIPIDA or DISIDA) scanning were performed on all patients. Patients in whom