RESULTS OF LAPAROSCOPIC CHOLECYSTECTOMY FOR THE TREATMENT OF GALLSTONE PANCREATITIS

Purpose: To assess the efficacy of laparoscopic cholecystectomy for th e treatment of acute gallstone pancreatitis. Methods: The charts of pa tients who underwent laparoscopic cholecystectomy between July 1990 an d March 1993 were reviewed. Data gleaned included age, duration of sym ptoms, physical exam, laboratory analysis, imaging studies, and postop erative course. Results: The diagnosis of gallstone pancreatitis was p resent in 29 of 510 patients (5.7%). The 20 females and nine males ran ged in age from 13 to 81 years with an average of 47 years. Twenty-six patients exhibited three or fewer of Ranson's criteria, and three had four criteria. All 29 patients underwent laparoscopic cholecystectomy without complications. Endoscopic retrograde cholangiogram (ERC) was done before operation in four patients, all normal studies. Laparoscop ic cholangiography was successful in 18 of the 22 patients in whom it was attempted. Common bile duct (CBD) stones were identified in three patients. Two had all stones cleared via the transcystic approach. The other had several stones removed from the CBD, but some stones were l eft in the hepatic duct. Postoperative ERC removed the remaining stone s. Twenty-two of the 29 (76%) patients were discharged within 2 days o f the operation, six were home by Day 6, and the last patient was disc harged on Day 16. Twenty-six patients were well in follow-up. Two pati ents returned 1 month after operation with an elevated serum amylase a nd lipase that promptly resolved. One patient was lost to follow-up. C onclusions: Laparoscopic cholecystectomy is effective for patients wit h acute gallstone pancreatitis and can be accomplished safely. Laparos copic cholangiography can be performed, can visualize the anatomy, and can address common bile duct stones. In most cases these patients can be successfully managed without ERC.