Thirty-seven patients with gallstone pancreatitis were encountered ove
r a 28-month period from June 1990 to October 1992. The use of laparos
copic cholecystectomy with intraoperative cholangiography in the manag
ement of gallstone pancreatitis was retrospectively studied. Thirty-tw
o women and 5 men ranged in age from 16 to 74 years. Admitting amylase
levels ranged from 241 to 5547 IU/L. No patient had a clinical histor
y consistent with other causes of pancreatitis, Initial treatment cons
isted of bowel rest until amylase levels had normalized and abdominal
tenderness had resolved. Twenty-nine of 37 patients were initially tre
ated laparoscopically, but 7 required conversion to open cholecystecto
my. Choledocholithiasis was identified intraoperatively in 4 patients.
These stones were cleared either laparoscopically (2), by open common
bile duct exploration (1), or by postoperative endoscopic retrograde
cholangiopancreatography (1). Patients treated laparoscopically had a
median postoperative discharge time of 1.0 day vs 3.5 days for those-t
reated by open technique. Not all patients with gallstone pancreatitis
can be treated successfully using laparoscopic techniques, As the exp
erience and confidence of surgeons increases, laparoscopic management
of gallstone pancreatitis is appropriate, with open conversion as nece
ssary.