Safety of Early Laparoscopic Cholecystectomy in Mild to Moderate Acute Pancreatitis

Abstract

Background: To assess safety of early laparoscopic cholecystectomy in patients of mild to moderate pancreatitis
Methods: In this observational study patients (n=25) of acute pancreatitis, mild to moderate, of billiary origin were included . Diagnosis of acute billiary pancreatitis was based on upper abdominal pain, serum amylase level 3 times normal and gall stones sludge on Ultrasonography. To assess severity of pancreatitis Ranson criteria for gall stone pancreatitis was used. Ranson criteria less or equal to 3 was taken as mild to moderate pancreatitis, where as more than 3 was taken as severe pancreatitis. All patients were operated on under general anaesthesia, with antibiotic cover. Callots triangle was dissected isolating cystic duct and cystic artery Four port technique was used. Both were clipped doubly, cut and gallbladder dissected out with blunt and sharp dissection. Haemostasis was obtained. Gallbladder extracted out through epigastric port. At end all free fluid was sucked out. 4 patients had ERCP 4 to 7 days back with endoscopic sphinctrotomy.
Results: All patients presented with pain in epigastrium and upper abdomen with vomiting . Once symptoms improved, amylase dropped down below 3 times normal, repeat ultra sonogram was done to rule out pancreatic necrosis then proceeded for laparoscopic cholecystectomy. All 25 patients were operated on successfully laparoscopically without open conversion. No bile duct and bowel injury was registered. Twenty patients had wide cystic duct, two cystic duct needed ligation with vicryl . Post operative course went smooth, but needed more analgesics as compared to routine elective laparoscopic cholecystectomy. Ten patients were discharged 48 hours after surgery and 15 after 72 hours of surgery. One patient develop pseudo pancreatic cyst 4 weeks after laparoscopic cholecystectomy, resolved on medical management. There was no mortality and 2 cases were re-admitted. Common bile duct injury was not registered and no case underwent open conversion. There was no mortality.
Conclusion: Early laparoscopic cholecystectomy is safe and cost effective in mild to moderate acute pancreatitis.