title: Acute postoperative pancreatitis after laparoscopic cholecystectomy. Results of the Prospective Swiss Association of Laparoscopic and Thoracoscopic Surgery Study.
abstract: BACKGROUND
  The introduction of laparoscopic cholecystectomy (LC) changed the treatment strategies for patients undergoing biliary surgery. There is a lack of data about acute postoperative pancreatitis (APP) as a complication of LC.
  
  
  OBJECTIVE
  To determine the incidence, morbidity, and mortality of APP after LC and to analyze the possible intraoperative and pathogenic factors associated with APP.
  
  
  METHODS
  A prospective cohort study of 10174 patients who underwent LC. The data for 32 patients with APP after the completion of LC and 8 patients with APP after an attempted LC that was converted to an open cholecystectomy were analyzed.
  
  
  METHODS
  A multi-institutional study of the Swiss Association of Laparoscopic and Thoracoscopic Surgery. Eighty-one surgical services or surgeons in private practice participated.
  
  
  RESULTS
  The incidence of APP after a completed LC was 0.34%. In comparison, the incidence of APP after conversion to an open procedure (0.96%) was significantly (P = .02) increased. A biliary origin of APP could be established in 4 (12.5%) of the 32 patients. No evidence for a causative role of intraoperative cholangiography or trauma to the pancreas was found. Factors shown to be associated with APP were the surgeon's experience level and a high morbidity of 31.3%. The mortality was 3%.
  
  
  CONCLUSIONS
  The incidence of APP after LC is low; the risk increases after conversion to an open procedure. In the rare event of an APP after LC, a biliary cause should be suspected. The mortality of patients with APP did decrease substantially compared with those undergoing open biliary surgery.
authors.affiliation: Swiss Association of Laparoscopic and Thoracoscopic Surgery, Bern, Switzerland. zgraggen@helix.mgh.harvard.edu
authors.forename: K
authors.initials: K
authors.lastname: Z'graggen
authors.forename: D
authors.initials: D
authors.lastname: Aronsky
authors.forename: C A
authors.initials: CA
authors.lastname: Maurer
authors.forename: C
authors.initials: C
authors.lastname: Klaiber
authors.forename: H U
authors.initials: HU
authors.lastname: Baer
mesh_terms: D000208:Acute Disease; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000453:epidemiology*; D011183:Postoperative Complications / Q000453:epidemiology*; D011446:Prospective Studies; D012307:Risk Factors; D017678:Sex Distribution; D012955:Societies, Medical; D013557:Switzerland / Q000453:epidemiology