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Biliary Pancreatitis: Operative Outcome With a Selective Approach

Biliary Pancreatitis: Operative Outcome With a Selective Approach Abstract • To evaluate the efficacy of a selective approach to biliary pancreatitis, we reviewed the outcomes in 276 consecutive patients undergoing operations for this diagnosis during a 7-year period. Initial conservative therapy resulted in elective operations in 63% and urgent operations in 37%. Only 10 patients (3.6%) required primary pancreatic operations, 50% of them as emergencies. The proportion of common duct surgical explorations fell from 70% of those operated immediately after hospital admission to 20% by the third hospital day. Overall mortality was 1.8% but was increased to 30% in patients having an initial pancreatic operation. We conclude that a selective approach to biliary pancreatitis allows the operation to be performed electively in most patients and is associated with a low mortality and an acceptable length of stay. Most common duct stones pass spontaneously permitting cholecystectomy alone. (Arch Surg. 1991;126:836-840) References 1. Acosta JM, Pelligrini CA, Skinner DB. Etiology and pathogenesis of acute biliary pancreatitis . Surgery . 1980;88:118-125. 2. Moreau JA, Zinsmeister AR, Melton LJ III, DiMagno EP. Gallstone pancreatitis and the effect of cholecystectomy: a population-based cohort study . Mayo Clin Proc . 1988;63:466-473.Crossref 3. Wilson L, Imrie CW, Carter DC. Fatal acute pancreatitis . Gut . 1988;29:782-788.Crossref 4. Puolakkainen P, Lempinen M, Schroder T. Fatal pancreatitis: a study of 64 consecutive cases . Acta Chir Scand . 1986;152:379-383. 5. Acosta JM, Rossi R, Galli OM, Pellegrini CA, Skinner DB. Early surgery for acute gallstone pancreatitis: evaluation of a systematic approach . Surgery . 1978;83:367-370. 6. Paloyan D, Skinner DB. The timing of biliary tract operations in patients with pancreatitis associated with gallstones . Surg Gynecol Obstet . 1975;141:737-739. 7. Semel L, Schrieber D, Fromm D. Gallstone pancreatitis: support for a flexible approach . Arch Surg . 1983;118:901-903.Crossref 8. Frei GJ, Frei VT, Thirlby RC, McClelland RN. Biliary pancreatitis: clinical presentation and surgical management . Am J Surg . 1986;151:170-175.Crossref 9. Glenn F, Frey C. Re-evaluation of the treatment of pancreatitis associated with biliary tract disease . Ann Surg . 1964;160:723-736.Crossref 10. Tondelli P, Stutz K, Harder F, Schuppisser J-P, Allgoer M. Acute gallstone pancreatitis: best timing for biliary surgery . Br J Surg . 1982;69:709-710.Crossref 11. Burch JM, Feliciano DV, Mattox KL, Jordan GL Jr. Gallstone pancreatitis: the question of time . Arch Surg . 1990;125:853-860.Crossref 12. Freund H, Pfeffermann R, Durst AL, Rabinovici N. Gallstone pancreatitis: exploration of the biliary system in acute and recurrent pancreatitis . Arch Surg . 1976;111:1106-1107.Crossref 13. Kim U, Shen H-Y, Bodner B. Timing of surgery for acute gallstone pancreatitis . Am J Surg . 1988;156:393-396.Crossref 14. Bates DM, Girvin GW. Biliary tract disease: is there a difference in men? Am J Surg . 1987;153:532-534.Crossref 15. Dougherty SH, Saltzstein EC, Peacock JB, Mercer LC, Cano P. Rapid resolution of high level hyperamylasemia as a guide to clinical diagnosis and timing of surgical treatment in patients with gallstones . Surg Gynecol Obstet . 1988;166:491-496. 16. Kourtesis GJ, Wilson SE, Williams RA. Safety of operation in biliary pancreatitis during the same hospitalization . Aust N Z J Surg . 1990;60:103-107. 17. Martin JK Jr, van Heerden JA, Bess MA. Surgical management of acute pancreatitis . Mayo Clin Proc . 1984;59:259-267.Crossref 18. Stone HH, Fabian TC, Dunlop WE. Gallstone pancreatitis: biliary tract pathology in relation to time of operation . Ann Surg . 1981;194:305-312.Crossref 19. Kelly TR. Gallstone pancreatitis . Arch Surg . 1974;109:294-297.Crossref 20. Ranson JH. The timing of biliary surgery in acute pancreatitis . Ann Surg . 1979;189:654-663.Crossref 21. Elfstrom J. The timing of cholecystectomy in patients with gallstone pancreatitis: a restrospective analysis of 89 patients . Acta Chir Scand . 1978;144:487-490. 22. Fielding GA, Mok F, Wilson C, Imrie CW, Carter VC. Management of gallstone pancreatitis . Aust N Z J Surg . 1989; 59:775-781.Crossref 23. Neoptolemos JP, London N, Slater ND, Carr-Locke DL, Fossard DP, Moosa AR. A prospective study of ERCP and endoscopic sphincterotomy in the diagnosis and treatment of gallstone acute pancreatitis . Arch Surg . 1986;121:697-702.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Biliary Pancreatitis: Operative Outcome With a Selective Approach

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Publisher
American Medical Association
Copyright
Copyright © 1991 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1991.01410310046006
Publisher site
See Article on Publisher Site

Abstract

Abstract • To evaluate the efficacy of a selective approach to biliary pancreatitis, we reviewed the outcomes in 276 consecutive patients undergoing operations for this diagnosis during a 7-year period. Initial conservative therapy resulted in elective operations in 63% and urgent operations in 37%. Only 10 patients (3.6%) required primary pancreatic operations, 50% of them as emergencies. The proportion of common duct surgical explorations fell from 70% of those operated immediately after hospital admission to 20% by the third hospital day. Overall mortality was 1.8% but was increased to 30% in patients having an initial pancreatic operation. We conclude that a selective approach to biliary pancreatitis allows the operation to be performed electively in most patients and is associated with a low mortality and an acceptable length of stay. Most common duct stones pass spontaneously permitting cholecystectomy alone. (Arch Surg. 1991;126:836-840) References 1. Acosta JM, Pelligrini CA, Skinner DB. Etiology and pathogenesis of acute biliary pancreatitis . Surgery . 1980;88:118-125. 2. Moreau JA, Zinsmeister AR, Melton LJ III, DiMagno EP. Gallstone pancreatitis and the effect of cholecystectomy: a population-based cohort study . Mayo Clin Proc . 1988;63:466-473.Crossref 3. Wilson L, Imrie CW, Carter DC. Fatal acute pancreatitis . Gut . 1988;29:782-788.Crossref 4. Puolakkainen P, Lempinen M, Schroder T. Fatal pancreatitis: a study of 64 consecutive cases . Acta Chir Scand . 1986;152:379-383. 5. Acosta JM, Rossi R, Galli OM, Pellegrini CA, Skinner DB. Early surgery for acute gallstone pancreatitis: evaluation of a systematic approach . Surgery . 1978;83:367-370. 6. Paloyan D, Skinner DB. The timing of biliary tract operations in patients with pancreatitis associated with gallstones . Surg Gynecol Obstet . 1975;141:737-739. 7. Semel L, Schrieber D, Fromm D. Gallstone pancreatitis: support for a flexible approach . Arch Surg . 1983;118:901-903.Crossref 8. Frei GJ, Frei VT, Thirlby RC, McClelland RN. Biliary pancreatitis: clinical presentation and surgical management . Am J Surg . 1986;151:170-175.Crossref 9. Glenn F, Frey C. Re-evaluation of the treatment of pancreatitis associated with biliary tract disease . Ann Surg . 1964;160:723-736.Crossref 10. Tondelli P, Stutz K, Harder F, Schuppisser J-P, Allgoer M. Acute gallstone pancreatitis: best timing for biliary surgery . Br J Surg . 1982;69:709-710.Crossref 11. Burch JM, Feliciano DV, Mattox KL, Jordan GL Jr. Gallstone pancreatitis: the question of time . Arch Surg . 1990;125:853-860.Crossref 12. Freund H, Pfeffermann R, Durst AL, Rabinovici N. Gallstone pancreatitis: exploration of the biliary system in acute and recurrent pancreatitis . Arch Surg . 1976;111:1106-1107.Crossref 13. Kim U, Shen H-Y, Bodner B. Timing of surgery for acute gallstone pancreatitis . Am J Surg . 1988;156:393-396.Crossref 14. Bates DM, Girvin GW. Biliary tract disease: is there a difference in men? Am J Surg . 1987;153:532-534.Crossref 15. Dougherty SH, Saltzstein EC, Peacock JB, Mercer LC, Cano P. Rapid resolution of high level hyperamylasemia as a guide to clinical diagnosis and timing of surgical treatment in patients with gallstones . Surg Gynecol Obstet . 1988;166:491-496. 16. Kourtesis GJ, Wilson SE, Williams RA. Safety of operation in biliary pancreatitis during the same hospitalization . Aust N Z J Surg . 1990;60:103-107. 17. Martin JK Jr, van Heerden JA, Bess MA. Surgical management of acute pancreatitis . Mayo Clin Proc . 1984;59:259-267.Crossref 18. Stone HH, Fabian TC, Dunlop WE. Gallstone pancreatitis: biliary tract pathology in relation to time of operation . Ann Surg . 1981;194:305-312.Crossref 19. Kelly TR. Gallstone pancreatitis . Arch Surg . 1974;109:294-297.Crossref 20. Ranson JH. The timing of biliary surgery in acute pancreatitis . Ann Surg . 1979;189:654-663.Crossref 21. Elfstrom J. The timing of cholecystectomy in patients with gallstone pancreatitis: a restrospective analysis of 89 patients . Acta Chir Scand . 1978;144:487-490. 22. Fielding GA, Mok F, Wilson C, Imrie CW, Carter VC. Management of gallstone pancreatitis . Aust N Z J Surg . 1989; 59:775-781.Crossref 23. Neoptolemos JP, London N, Slater ND, Carr-Locke DL, Fossard DP, Moosa AR. A prospective study of ERCP and endoscopic sphincterotomy in the diagnosis and treatment of gallstone acute pancreatitis . Arch Surg . 1986;121:697-702.Crossref

Journal

Archives of SurgeryAmerican Medical Association

Published: Jul 1, 1991

References