title: Acute gallstone pancreatitis: timing of laparoscopic cholecystectomy in mild and severe disease.
abstract: BACKGROUND
  In acute gallstone pancreatitis, the ideal point in time for laparoscopic cholecystectomy with special reference to the severity of the disease has been prospectively analyzed.
  
  
  METHODS
  A total of 77 patients with biliary acute pancreatitis were admitted between November 1993 and July 1998 (37 men and 40 women; mean age, 63 years; median Apache II score, 13.3) and staged by contrast-enhanced computed tomography findings as having edematous or necrotizing disease.
  
  
  RESULTS
  In 48 patients, laparoscopic cholecystectomy was found to be possible: 35 patients (73%) with mild and 13 patients (27%) with severe acute pancreatitis. The overall success rate was 79% (38 of 48 patients), with 85% (30 of 35 patients) and 62% (8 of 13 patients) having mild and severe disease, respectively. Median duration of time between onset of symptoms and surgery was 10 days (range, 4-19 days) in edematous and 14 days (range, 7-29 days) in necrotizing pancreatitis (p = 0.0353). Operating time (median, 80 min) and hospital stay (median, 5 days) were almost the same in both groups. Total morbidity was 8%, with no mortality.
  
  
  CONCLUSIONS
  Laparoscopic cholecystectomy with preoperative endoscopic common bile duct clearance is recommended as a treatment of choice for biliary acute pancreatitis. In mild disease, this is performed safely within 7 days, whereas in severe disease, especially in extended pancreatic necrosis, at least 3 weeks should elapse because of an increased infection risk.
authors.affiliation: Department of Visceral and Transplantation Surgery, University Hospital of Bern, CH-3010 Bern, Switzerland.
authors.forename: W
authors.initials: W
authors.lastname: Uhl
authors.forename: C A
authors.initials: CA
authors.lastname: Müller
authors.forename: L
authors.initials: L
authors.lastname: Krähenbühl
authors.forename: S W
authors.initials: SW
authors.lastname: Schmid
authors.forename: S
authors.initials: S
authors.lastname: Schölzel
authors.forename: M W
authors.initials: MW
authors.lastname: Büchler
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002760:Cholangiopancreatography, Endoscopic Retrograde; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D002769:Cholelithiasis / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000145:classification / Q000000981:diagnostic imaging / Q000601:surgery*; D011446:Prospective Studies; D012720:Severity of Illness Index