Safety of operation in biliary pancreatitis during the same hospitalization.
Over the past 4 years, 61 patients with biliary pancreatitis were managed, 48 of whom had operation on the biliary tree within the same hospital admission. Initial therapy was medical and operation was performed at a median of 6 days from admission (range: 3-14 days). Two patients required surgery for non-resolution of the pancreatitis, but the other 44 patients had clinical and biochemical resolution prior to surgery. At operation, oedematous-interstitial pancreatitis was found in 18 patients, necrotizing pancreatitis in two and a normal pancreas in 28 patients. Common duct exploration in 15 patients resulted in 10 positive explorations. One death occurred in a patient with necrotizing pancreatitis and an impacted stone, but overall morbidity was low and total hospitalization in the operated group averaged 12 days. There was a statistically significant difference in the incidence of bile duct stones (five of 10 versus seven of 38, P = 0.019) and operative findings of pancreatitis (seven of 10 versus 11 of 38, P = 0.038) in patients having surgery before or after 4 days of hospitalization. Initial conservative management for 4 days allows resolution of pancreatitis in most patients, minimizing the need for and potential risk from common duct exploration.
Kourtesis
G J
GJ
Department of Surgery, Harbor/UCLA Medical Center.
Wilson
S E
SE
Williams
R A
RA
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000681:Amylases / Q000097:blood; D002769:Cholelithiasis / Q000150:complications / Q000601:surgery*; D005069:Evaluation Studies as Topic; D005260:Female; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000097:blood / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography
D000681:Amylases