Acute biliary pancreatitis in the era of minimally invasive surgery.
OBJECTIVE
Opinions about early endoscopic sphincterotomy and time of laparoscopic cholecystectomy in acute biliary pancreatitis are still controversial. Some authors reserved this procedure only for cases in which the stones were visualized during ERCP or patients had clinical symptoms of acute cholangitis. The aim was the assessment of the dynamic of changes of proinflammatory cytokines and white blood cells in time in patients with acute biliary pancreatitis after performed endoscopic sphincterotomy and laparoscopic cholecystectomy.


METHODS
We enrolled 43 consecutive patients with clinically diagnosed mild forms of acute biliary pancreatitis. All were treated by early endoscopic sphincterotomy and laparoscopic cholecystectomy performed during the first 48 hours after admission. The course of the disease was monitored by measurement of the level of proinflammatory cytokines.


RESULTS
Marked decrease of the level of proinflammatory interleukins within 24 hours after endoscopic sphincterotomy was observed. Mean values of IL-6 and IL-8 were statistically lower immidiately after this procedure (p < 0.001). Subsequent decrease was achieved after laparoscopic cholecystectomy. The mean values of TNF-alpha and IL-12p40 were relatively constant throughout the study period.


CONCLUSIONS
All patients suffering from mild acute biliary pancreatitis should be treated by using minimally invasive procedures. However, such a only treatment should be reserved for experienced centers.
Panek
J
J
2nd Surgical Department, Jagiellonian University, Collegium Medicum ul. Kopernika 21, 31-501 Kraków, Poland. mspanek@cyf-kr.edu.pl
Rembiasz
K
K
Karcz
D
D
Winiarski
M
M
Zasada
J
J
D000208:Acute Disease; D001660:Biliary Tract Diseases / Q000097:blood / Q000150:complications / Q000601:surgery*; D017081:Cholecystectomy, Laparoscopic / Q000379:methods; D006801:Humans; D053762:Interleukin-12 Subunit p40 / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D016209:Interleukin-8 / Q000097:blood; D007958:Leukocyte Count; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D010195:Pancreatitis / Q000097:blood / Q000209:etiology / Q000601:surgery*; D016717:Sphincterotomy, Endoscopic / Q000379:methods; D013997:Time Factors; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000097:blood
D053762:Interleukin-12 Subunit p40; D015850:Interleukin-6; D016209:Interleukin-8; D014409:Tumor Necrosis Factor-alpha