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Management of Simple Gallstone Pancreatitis in 1285 Consecutive Cholecystectomies

Meghna Misra, Jeffrey Schiff, Gonzalo Rendon, Janice Rothschild, Steven Schwaitzberg
Tufts-New England Medical Center, Boston, MA

Objective: To analyze trends of management of gallstone pancreatitis (GP).
Design: Retrospective review of 1285 consecutive cholecystectomy (CCY) pts operated between 1996 and 2003.
Setting: Tertiary Care Medical Center
Patients:
48 consecutive pts with simple GP from the 1285 pt case series
Interventions:
Surgical management of GP and ductal imaging
Main Outcome Measures: Major or minor ductal injuries, acute and long-term complications, ductal imaging, amylase and lipase levels.
Results:
Of 59 pts with GP, 48 had simple hyperamylasemia (SHA) - a short and transient rise in serum amylase. 43 pts: laparoscopic cholecystectomy (LC), 3: open CCY, 2: LC converted to open surgery. 26/48 pts underwent surgery during the same admission of their SHA episode. The rest were performed 2 to16 weeks after their GP attack. 17/43 LCs were performed with cholangiogram (IOC) (no pre-op ERCP) - four were positive. 23 pts had pre-op ERCP - six were positive. 8 pts had neither pre-op ERCP nor IOC, and all 8 had benign post-op courses.
Conclusions:
Preoperative routine ERCP in simple GP is unnecessary unless persistent elevations of LFTs or amylase are present. Pre-op ERCP increases cost associated with management of GP. Our SHA pts, who had no ductal imaging, did well post-operatively. This allowed us to question whether or not SHA is an absolute indication for ductal imaging. Simple GP slightly increases the conversion rate to open surgery, but LC is a safe procedure for the management of simple GP during the same admission as the initial attack.

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