Early surgery for acute gallstone pancreatitis: evaluation of a systematic approach.

Abstract

A consecutive series of I32 patients with acute gallstone pancreatitis admitted within 48 hours of the onset of symptoms was studied. According to the treatment employed, the series was divided into two groups. Both groups were similar in regard to age,-incidence of associated conditions, and delay in receiving therapy. Group I was comprised of 86 patients who, betweeen I964 and 1972, received conventional medical treatment complemented in most cases with surgery, either elective to treat the associated gallstone disease or urgent to treat acute abdominal complications of pancreatitis. In these latter patients, lesions of advanced acute pancreatitis, such as extensive hemorrhagic necrosis, pseudocysts, and abscesses, were found at operation. croup II included 46 patients, who, between 1972 and 1975, were operated on upon admission-between 6 and 48 hours from the onset of the crisis (average, 28 hours), without receiving any other treatment. Operative findings in these patients showed edematous pancreatitis in the majority of patients. A gallstone impacted at the ampulla of Vater was found in 33 of the 46 patients. Disobstruction, including sphincterotomy in 14 patients, was carried out in all of them. Other surgical procedures indicated in gallstone disease were performed concomitantly. Overall mortality rate was 11% for the whole series: 16% for group I and 2% for Group II (chi square = 4.60; p < 0.05). The admission period averaged 25 days in group I and I3 days in group II. These fkdings suggest that the degree and duration of ampullary obstruction are important determinants for the severity of pancreatitis. Therefore, ear& relief of the obstruction is a critical factor for recovery. To achieve this goal, early and systematic surgical removal of the impacted gallstone seems to be more reliable and more safe than classic conservative therapy.