Early laparoscopic cholecystectomy in acute biliary pancreatitis: the optimal choice?
The optimal time for managing cholelithiasis in acute biliary pancreatitis (ABP) is still controversial. One hundred and nineteen consecutive patients of ABP were taken up for the study after grouping them according to Glasgow modification of Ranson's criteria. Twelve patients with severe acute pancreatitis were excluded from the study. Laparoscopic cholecystectomy (LC) was carried out during the same admission in 81 patients, while 26 patients opted for interval LC after six weeks. The results were analysed in terms of difficult dissection, operating time, complications and discharge time. The parameters of the patients undergoing early laparoscopic cholecystectomy (ELC) were then compared with those undergoing interval LC and 90 control patients who underwent elective LC for cholelithiasis. There was no difference in the operative parameters among the three groups except that dissection was significantly more difficult in patients being operated after six weeks of the attack. Also in those being operated immediately after the attack, significantly greater number of patients required a fourth port for completion of surgery as compared to the control patients. ELC in patients with mild acute biliary pancreatitis appears to be a viable and better alternative to interval cholecystectomy.
Sinha
Rajeev
R
Department of Surgery, MLB Medical College, Jhansi, India. sinha_rga@ yahoo.co.in