Single-stage laparoscopic management of acute gallstone pancreatitis: outcomes at different timings.
BACKGROUND
Definitive therapy for gallstone pancreatitis requires eradication of gallstones with cholecystectomy and common bile duct (CBD) clearance. Current guidelines recommend this be done within the same admission and preferably by laparoscopic cholecystectomy and CBD exploration. We report our experience of laparoscopic single-stage management with cholecystectomy and intraoperative cholangiogram followed by laparoscopic bile duct exploration (LBDE) when necessary performed at three different stages.


METHODS
From January 1998 to December 2012, 134 patients (100 females and 34 males) underwent single-stage laparoscopic management of gallstone pancreatitis. Patients were classified according to the timing of surgery: "A", ≤7 days from symptom onset (n=27); "B", 8 to 30 days (n=58) and "C", >30 days (n=49).


RESULTS
LBDE was performed in 30 patients with a success rate of 100%. CBD stones were found in 25 patients (A: 22.2%, B: 22.4%, C: 12.2%). CBD stones were more common in patients undergoing surgery within 30 days of presentation than after this time point (P=0.35). Multiple choledocholithiasis was more frequent in patients treated within 7 days (P=0.04). The 30-day mortality after surgery was 0, with no conversion to an open approach. Overall complication rate was 11.9%, which did not differ significantly between patients treated within 7 days or after this time point (P=0.83).


CONCLUSIONS
This study demonstrated the feasibility and reproducibility of single-stage laparoscopic management of acute gallstone pancreatitis, which has a low complication rate at any stage. Patients undergoing early treatment have a higher incidence of choledocholithiasis and multiple stones than those treated after 30 days, supporting the passage of stones with time.
Northwick Park and St Mark's Hospital, North West London Hospitals NHS Trust, Watford Road, Harrow, Middlesex, London, HA1 3UJ, UK. a.isla@imperial.ac.uk.
Antonio
A
Navarro-Sanchez
Hutan
H
Ashrafian
Aggelos
A
Laliotis
Kamran
K
Qurashi
Alberto
A
Martinez-Isla
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects; D042883:Choledocholithiasis / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D003135:Common Bile Duct / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D042882:Gallstones / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008131:London; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D061665:Time-to-Treatment; D016896:Treatment Outcome; D055815:Young Adult