Laparoscopy in acute biliary pancreatitis

Background. The high mortality rates (20-30%) still occurring in some forms of acute pancreatitis demands adequate clinical and instrumental protocols in order to establish the most suitable therapeutic option to employ. The use of laparoscopic surgery can reduce hospital stay and time for functiona l recovery. Methods. The study enrolled 73 patients referring for acute biliary pancrea titis in whom staging with clinical, laboratory and instrumental criteria w as performed. According to Ranson classification 63 patients (86.3%) had a mild-moderate acute biliary pancreatitis, 10 (13.6%) a severe one. In the f irst group laparoscopic cholecystectomy with retrograde cholangiography was performed within seven days of admission, in the second group surgical pro cedure followed medical treatment between eight and 30 days after the onset of the disease. No preoperative ERCP was performed. Results. The rate of main biliary tract calculosis was 8.2% in group A: six cases all treated through laparoscopy. Two switches (2.7%) due to intolera nce to the pneumoperitoneum, eight major postoperative complications (10.9% ), and two deaths (2.7%) occurred and a mean hospital stay of 7.4 days was observed in group A versus 8.2 days in group B. Conclusions. The management suggested in this study for mild-moderate acute biliary pancreatitis showed consistent results with those of the recent li terature, as far as morbidity (6.3%) and mortality (1.5%) are concerned. A higher number of severe biliary pancreatitis (10 cases) should be observed to assess the role of ERCP with endoscopic sphincterotomy rather than lapar oscopic or combined treatment.