Lviv clinical bulletin 2016, 2(14)-3(15): 51-54

https://doi.org/10.25040/lkv2016.023.051

Laparoscopic Cholecystectomy in Patients with Mild Acute Biliary Pancreatitis

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A. Reiti, A. Golovin, I. Yatsyk

Shupyk National Medical Academy of Postgraduate Education

Introduction. Over the last few decades, the incidence of acute pancreatitis is increasing, partly due to the increasing number of patients with cholelithiasis, which is the reason of 27,0-62,0 % of cases. Therefore, an adequate treatment of patients with acute pancreatitis remains a very important clinical problem.

Aim. To compare the results of early and delayed laparoscopic cholecystectomy in patients with mild acute biliary pancreatitis, based on the assessment of intra-, early and long-term effects of early surgery.

Materials and methods. To estimate intra-, early and late postoperative complications in a randomized manner were selected 145 patients with a first episode of mild acute biliary pancreatitis (64 women and 81 men aged 18 – 76 years). Diagnosis was established on the basis of the international standards (Banks P. A., Freeman M. L., 2006), biliary pancreatitis genesis was confirmed by the visualization of the calculus or biliary sludge in gallbladder, using ultrasonography and severity of pancreatitis patients was determined by the criteria of J. H. C. Ranson (1974). All the patients were stratified into two groups: 49 patients (23 women and 26 men aged 18 to 72 years) in the group, for which the laparoscopic cholecystectomy was performed within 72 hours after the elimination of the symptoms of acute pancreatitis; 96 patients in comparison group (46 women and 50 men aged 18 – 76 years), for which surgeries were performed in 4-8 weeks after the discharge from the hospital. Statistical indices calculation was performed using a standard software (Statistica, Version 6, StatSoft, Inc) with determination criterion of K. Pearson – χ2. The difference was considered significant, when p < 0.05.

Results and discussion. The evaluation of the frequency of early complications of laparoscopic cholecystectomy (in particular, biloma; leakage of blood from the bed of the gallbladder or bile from the bile ducts; trocar festering wounds), as well as the need for drainage of the abdominal cavity, intraoperative use of additional diagnosis methods, carrying out the conversion.

After the early cholecystectomy in patients with acute biliary pancreatitis significantly more often occurred the need of drainage in the abdomen and the use of the additional intraoperative diagnosis methods, that was caused by the severe anatomical terms. In two cases, the transition was required to open surgeries (p < 0.05). Therefore, performing laparoscopic cholecystectomy was observed the CVS (critical-view-of-safety) principle, standardized operating techniques for positive identification of the gall bladder, cystic duct and artery. Two patients (p < 0.05) were transferred in postoperative period into the intensive care unit and needed intensive care due to the deterioration of their condition. If the doctors of the patients gave preference to delayed cholecystectomy, in the remote postoperative period the proportion of the patients with extrahepatic bile duct obstruction and recurrent acute pancreatitis, which ran normally in severe form was significantly increased (p < 0.05).

Conclusions. Early cholecystectomy in patients with mild acute biliary pancreatitis prevent the recurrence of biliary pancreatitis and the occurrence of other complications of gallstones diseases, compared with the delayed surgery. However, this tactic is potentially dangerous due to intra- and early postoperative complications, requiring high qualification of operating surgeon and often additional financial support.

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