ROLE OF LAPAROSCOPIC CHOLECYSTECTOMY IN THE MANAGEMENT OF ACUTE GALLSTONE PANCREATITIS

Laparoscopic cholecystectomy has rapidly become the prime modality for removal of the gallbladder. However, as laparoscopic techniques for t reating choledocholithiasis are evolving, we reviewed our experience w ith acute gallstone pancreatitis since the inception of laparoscopic c holecystectomy. Between November 1989 and March 1993, we treated 57 pa tients with acute gallstone pancreatitis. Cholecystectomy was performe d during the initial admission in 46 patients (81%, group I), while 11 (19%) underwent delayed cholecystectomy at a second admission 2 to 9 weeks later (group II). Within group I, eight patients (17%) were thou ght to have contraindications to laparoscopic cholecystectomy and unde rwent open cholecystectomy. In the remaining 38 patients of group I, l aparoscopic cholecystectomy was completed successfully. Preoperative e ndoscopic retrograde cholangiopancreatography (ERCP) was performed in 23 of these patients (61%) and endoscopic sphincterotomy was performed in 6 patients (26%). In four other patients, the intraoperative chola ngiogram revealed common bile duct stones that were removed using lapa roscopic techniques. The 11 patients in group II were all treated by l aparoscopic cholecystectomy; of these patients, 3 underwent preoperati ve endoscopic stone removal and 1 had choledocholithiasis managed lapa roscopically. Postoperative hospitalization averaged 4 +/- 1 days (mea n +/- SEM), and there was no major morbidity or 30-day mortality. This is the first large series of acute gallstone pancreatitis in the era of laparoscopic cholecystectomy. Our experience suggests that laparosc opic cholecystectomy with or without ERCP should be the primary approa ch for treating acute gallstone pancreatitis in the 1990s.