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| Single-stage laparoscopic management of acute gallstone pancreatitis: outcomes at different timings |
| Antonio Navarro-Sanchez, Hutan Ashrafian, Aggelos Laliotis, Kamran Qurashi and Alberto Martinez-Isla |
London, UK
Author Affiliations: Northwick Park and St Mark’s Hospital, North West London Hospitals NHS Trust, Watford Road, Harrow, Middlesex, London, HA1 3UJ, UK (Navarro-Sanchez A, Ashrafian H, Qurashi K and Martinez-Isla A); Department of Surgery and Cancer, Imperial College London, 10th Floor QEQM Building, St Mary’s Hospital, Praed Street, W2 1NY, UK (Ashrafian H); Guy’s and St. Thomas’ NHS Foundation Trust, Great Maze Pond, London, SE1 9RT and Westminster Bridge Road, London, SE1 7EH, UK (Laliotis A); and Ealing Hospital NHS Trust, Uxbridge Rd, Southall, Middlesex, UB1 3HW, UK (Qurashi K)
Corresponding Author: Alberto Martinez-Isla, FRCS, Consultant Surgeon, Department of Upper GI Surgery, Northwick Park Hospital, North West London Hospitals NHS Trust, Watford Road, Harrow, Middlesex, London, HA1 3UJ, UK (Tel: +44-208-453-2619; Fax: +44-208-242-5912; Email: a.isla@imperial.ac.uk) |
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Abstract 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.
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2016, Vol. 15 
