URGENT ERCP AND EARLY-ELECTIVE LAPAROSCOP IC CHOLECYSTECTOMY IN GALLSTONE PANCREATITIS

Background: For many years the best algorithm of treatment for complic ated gallstone disease has been intensively discussed. Gallstone pancr eatitis with cholangitis still belongs to the most often identified ca uses of death of necrotizing pancreatitis. The reduction of complicati on and lethality rates was mainly achieved by urgent ERCP and sequenti al cholecystectomy. In a prospective study we have combined endoscopic therapy with laparoscopic cholecystectomy (LC) and are discussing the results. Patients and Methods: Between May 1991 and December 1996 146 patients with biliary pancreatits were subjected to ERCP after labora tory tests and ultrasound screening of the biliary system. If there we re no contraindications and the gallbladder was still in situ, LC was attempted during the initial admission. Results: Of the 70 patients wi th attempted LC 26 had common bile duct calculi, 23 had an impacted pa pillary stone and 10 had signs of a stone passage. 59 patients underwe nt LC successfully, a conversion to open surgery was necessary in 11 p atients. The morbidity rate amounted to 7%, lethality to 0%. Discussio n: Since a more liberal indication for ERCP in the management of acute pancreatitis was introduced the number of biliary related cases of ac ute pancreatitis is increasing. In response to early endoscopic bile d uct clearance the rates of morbidity and mortality can be significantl y reduced. Early LC is the ideal complementary treatment option to abs olutely prevent recurrencies.