ACUTE POSTOPERATIVE PANCREATITIS AFTER LAPAROSCOPIC CHOLECYSTECTOMY -RESULTS OF THE PROSPECTIVE OCIATION-OF-LAPAROSCOPIC-AND-THORACOSCOPIC-SURGERY STUDY

Background: The introduction of laparoscopic cholecystectomy (LC) chan ged the treatment strategies for patients undergoing biliary surgery. There is a lack of data about acute postoperative pancreatitis (APP) a s a complication of LC. Objectives: To determine the incidence, morbid ity, and mortality of APP after LC and to analyze the possible intraop erative and pathogenic factors associated with APP. Design: A prospect ive cohort study of 10 174 patients who underwent LC. The data for 32 patients with APP after the completion of LC and 8 patients with APP a fter an attempted LC that was converted to an open cholecystectomy wer e analyzed. Setting: A multi-institutional study of the Swiss Associat ion of Laparoscopic and Thoracoscopic Surgery. Eighty-one surgical ser vices or surgeons in private practice participated. Results: The incid ence of APP after a completed LC was 0.34%. In comparison, the inciden ce of APP after conversion to an open procedure (0.96%) was significan tly (P=.02) increased. A biliary origin of APP could be established in 4 (12.5%) of the 32 patients. No evidence for a causative role of int raoperative cholangiography or trauma to the pancreas was found. Facto rs shown to be associated with APP were the surgeon's experience level and a high morbidity of 31.3%. The mortality was 3%. Conclusions: The incidence of APP after LC is low; the risk increases after conversion to an open procedure. In the rare event of an APP after LC, a biliary cause should be suspected. The mortality of patients with APP did dec rease substantially compared with those undergoing open biliary surger y.