THE ROLE OF ERCP AND LAPAROSCOPIC CHOLECYSTECTOMY IN GALLSTONE-RELATED PANCREATITIS

Laparoscopic surgery has become the routine for elective cholecystecto my, but its place in the management of gallstone-related pancreatitis has not yet been identified. We prospectively assessed a minimally inv asive treatment regime for gallstone pancreatitis combining endoscopic retrograde cholangiopancreatography (ERCP) and laparoscopic cholecyst ectomy, over a 24 month period. Twenty-two patients were found to have gallstone pancreatitis. The mean age was 52 +/- years. All patients p resented with abdominal pain. Five were jaundiced. The Ranson score se verity of pancreatitis averaged 1.6 (range 0-6). Our management protoc ol was to perform ERCP when clinical and biochemical markers had settl ed, followed by laparoscopic cholecystectomy during the same admission . The time interval between presentation and ERCP was 8.9 d (range 2-1 5 d), ERCP to surgery was 4.5 d (range 2-35 d) and surgery to discharg e was 4 d (range 1-21 d). The median hospital stay was 16 d. ERCP show ed stones in the common bile duct in five patients, four of whom had t hem removed at ERCP. Twenty patients underwent laparoscopy. The gallbl adder was removed in 18 and two required conversion (one pseudocyst, o ne cystic artery bleed). Two patients had elective open cholecystectom y (one pseudocyst, one previous surgery). Only one patient developed a post-operative complication (pseudocyst). The majority of patients ha d multiple small stones in their gallbladder and it was not possible t o predict the presence of common bile duct stones prior to ERCP. No pa tient developed post-operative pancreatitis. There was no mortality. T his study shows that combined ERCP and laparoscopic cholecystectomy is an efficient and safe minimally invasive management for gallstone pan creatitis.