Gallstone pancreatitis: the timing of surgery
Kelly, T.R.
Surgery 88(3): 345-350
1980
ISSN/ISBN: 0039-6060 PMID: 7414512 Document Number: 163786
The timing of surgery in gallstone pancreatitis has remained controversial. One hundred and seventy-two patients with gallstone pancreatitis were studied in 3 groups. Group I patients (24) underwent early surgery (within 72 h) during an attack of acute pancreatitis. The surgery in the patients of group II (134) was delayed (5 to 7 days) until the acute pancreatitis had resolved. Group III patients (14) were treated nonoperatively during the acute attack of pancreatitis and operated on electively during a subsequent hospital admission. Stones were recovered from the stools of 86% of the group II patients. Impacted ampullary stones were found in 63% of the group I patients, but in only 5% of the patients in group II that underwent delayed surgery. Of the group III patients who were discharged without definitive biliary tract surgery, 38% developed recurrent gallstone pancreatitis. The surgical mortality rates were 12% in group I patients, 0.0% in group II and 7% in group III. The overall mortality rate for all groups was 2.3%. Delayed surgery apparently should be employed in patients with gallstone pancreatitis, since spontaneous stone passage and resolution of the pancreatitis will occur in about 85% of cases allowing for safer surgery. Early surgery should be reserved for patients (about 15%) in whom stone passage does not take place and the pancreatitis progresses. All patients should be operated on at the initial hospital admission, since the natural history of gallstone pancreatitis is one of frequent recurrence.