title: Therapeutic approach and prevention in recurrent acute biliary pancreatitis.
abstract: OBJECTIVE
  Acute biliary pancreatitis (ABP) is caused by alteration of the papillary patency. The normal transpapillar flux and the cleaning of the common biliary duct (CBD) may prevent potentially avoidable recurrent pancreatitis.
  
  
  METHODS
  In the period September 1997/December 2008 we have treated 224 ABP (34 severe, 190 mild/moderate): 162 (72,4%) with the first attack, 62 (27.6%) with recurrent ABP (second or further attack). The patients with recurrent pancreatitis had not undergone, in the previous hospital stay elsewhere, the evaluation and, if necessary, the treatment of the papillary obstacle and/or CBD stones, sludge, etc. In our hospital all patients had undergone the treatment of ABR The treatment was completed with cholecystectomy. All the patients, after the discharge, were introduced in a follow-up program (clinical and ultrasonographic (US) control after 180 days and 1 year).
  
  
  RESULTS
  In the follow-up of recurrent pancreatitis we have controlled 35 patients (56%-27 lost). The results of the follow-up showed, beside the absence of recurrent acute episodes, the stable normalization of laboratory cholestasis tests and US control. The same controls in 78 patients (48.1%) with a first attack of acute pancreatitis resulted normal in absence of a new acute episode.
  
  
  CONCLUSIONS
  Recurrent ABP have been caused by persistent papillary obstacle. Therefore we confirm therapeutic validity of the instrumental control (US/MRCP) and the possible treatment of papillary or biliary lithiasic obstacle for the prevention of recurrent ABP?
authors.affiliation: Department of Surgical Sciences, Division of General Surgery, University of Foggia, Polyclinic Ospedali Riuniti Foggia, Italy. v.neri@unifg.it
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Neri
authors.forename: Antonio
authors.initials: A
authors.lastname: Ambrosi
authors.forename: Alberto
authors.initials: A
authors.lastname: Fersini
authors.forename: Nicola
authors.initials: N
authors.lastname: Tartaglia
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002763:Cholecystectomy; D017081:Cholecystectomy, Laparoscopic; D002769:Cholelithiasis / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D012189:Retrospective Studies; D055502:Secondary Prevention; D012720:Severity of Illness Index; D016896:Treatment Outcome