Early endoscopic sphincterotomy and early laparoscopic cholecystectomy in the treatment of severe acute biliary pancreatitis--a preliminary report.
OBJECTIVE
The proper timing of endoscopic sphincterotomy and laparoscopic cholecystectomy in acute biliary pancreatitis is still a subject of controversies. The following rapid report presents preliminary data concerning treatment of patients with severe form of necrotizing biliary pancreatitis (SNBP) with the sequence of minimal invasive procedures (endoscopic sphincterotomy and laparoscopic cholecystectomy) performed in the first 48 hours after admission.


METHODS
Twelve patients with SNBP were included in the study. The described above procedures were performed in all of the patients within 48 hours. We evaluated clinical outcome, complications, time of stay in hospital and also some morphological (white blood cells) and liver parameters (AST, ALT, bilirubin, ALP and GGT) of these patients in the course of the disease.


RESULTS
Two patients died. Two other ones has local complications. We did not observe major complications after ERCP with ES and after laparoscopic cholecystectomy. Additionally, the lavage of the abdominal cavity was performed and drainage was established during laparoscopic cholecystectomy. Conversion in our group occurred in 1 person. Later complications in the course of the disease were caused by the its progression and not related to the performed procedures.


CONCLUSIONS
The results are very incurable, however, performing these types of procedures in the experienced centers deserves to be taken into account.
Panek
J
J
2nd Chair of General Surgery, Jagiellonian University, Collegium Medicum, Kraków, Poland. mspanek@cyf-kr.pl
Karcz
D
D
Rembiasz
K
K
Budzyński
A
A
Zasada
J
J
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001660:Biliary Tract Diseases / Q000150:complications / Q000601:surgery*; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019283:Pancreatitis, Acute Necrotizing / Q000209:etiology / Q000601:surgery*; D012720:Severity of Illness Index; D016717:Sphincterotomy, Endoscopic / Q000379:methods*; D016896:Treatment Outcome