Management of biliary pancreatitis in the Laparoscopic Era

Background: The treatment strategy for biliary pancreatitis varies according to the locations of biliary stones and the severity of the pancreatitis. The role and the timing of Endoscopic Retrogradc Cholangio Pancreatography (ERCP) in biliary pancreatitis have not yet been defined, and recently a laparoscopic cholecystectomy has emerged as a useful means in biliary pancreatitis. Methods: From December 1986 to June 1997, a total of 66 patients (31 males and 35 females) presented with acute biliary pancreatitis at our institution. The medical records were reviewed to determine the diagnostic tools, the location of the gallstone, the severity of the pancreatitis according to Ranson's prognostic score, the timing of ERCP or surgical intervention, the morbidity, and the mortality of each treatment. Results: Most biliary stones were found in the gallbladder, and Common bile duct (CBD) stones, which could be removed via ERCP or choledocholithotomy, were identified in 10 cases (15%). Most patients (86%) were classified as having a mild attack (Ranson's score≤2) of acute pancreatitis. There was no statistical significance in the timing of each treatment modality between the mild and the severe pancreatitis groups. Conclusions: ERCP was a safe and helpful adjunct for managing CBD stones. The laparoscopic cholecystectomy was proved to be a safe and effective measure for managing gallbladder stones in resolving biliary pancreatitis. However, open surgery was still necessary when pancreatitis-related complications occurred.ope