LAPAROSCOPIC CHOLECYSTECTOMY FOR BILIARY PANCREATITIS

A prospective study was undertaken to assess the technical difficulty of early laparoscopic cholecystectomy for acute biliary pancreatitis. Patients underwent early endoscopic retrograde cholangiography (ERC) a nd laparoscopic cholecystectomy was performed after signs of clinical improvement. Five steps were assessed during surgery using a visual an alogue score. These patients were compared with a control group underg oing elective surgery for chronic symptomatic gallstones. Of 24 patien ts aged 28-83 (median 60) years, eight had three or more positive sign s according to Ranson's criteria. Twenty-three patients underwent succ essful ERC; seven had choledocholithiasis and were managed endoscopica lly. Laparoscopic cholecystectomy performed 3-24 (median 7) days after admission was successful in 21 of the 24 patients. The mean(s.d.) ope rative difficulty score was significantly increased in patients with a cute biliary pancreatitis compared with that in the 40 controls (5.4(1 .8) versus 3.6(1.4), P<0.002), particularly for dissection of Calot's triangle (6.5(1.5) versus 3.0(1.6), P<0.001). A dilated cystic duct wa s present in over 50 per cent of patients and in seven could not be sa fely closed with a clip; this finding was not predicted by ERC. Biliar y pancreatitis is a further indication for laparoscopic cholecystectom y. Early surgery is safe but technical difficulty is increased. Cystic duct dilatation must be anticipated; an externally tied ligature in c ontinuity is recommended.