Acute gallstone pancreatitis: timing of laparoscopic cholecystectomy in mild and severe disease

Surg Endosc. 1999 Nov;13(11):1070-6. doi: 10.1007/s004649901175.


Background: In acute gallstone pancreatitis, the ideal point in time for laparoscopic cholecystectomy with special reference to the severity of the disease has been prospectively analyzed.

Methods: A total of 77 patients with biliary acute pancreatitis were admitted between November 1993 and July 1998 (37 men and 40 women; mean age, 63 years; median Apache II score, 13.3) and staged by contrast-enhanced computed tomography findings as having edematous or necrotizing disease.

Results: In 48 patients, laparoscopic cholecystectomy was found to be possible: 35 patients (73%) with mild and 13 patients (27%) with severe acute pancreatitis. The overall success rate was 79% (38 of 48 patients), with 85% (30 of 35 patients) and 62% (8 of 13 patients) having mild and severe disease, respectively. Median duration of time between onset of symptoms and surgery was 10 days (range, 4-19 days) in edematous and 14 days (range, 7-29 days) in necrotizing pancreatitis (p = 0.0353). Operating time (median, 80 min) and hospital stay (median, 5 days) were almost the same in both groups. Total morbidity was 8%, with no mortality.

Conclusions: Laparoscopic cholecystectomy with preoperative endoscopic common bile duct clearance is recommended as a treatment of choice for biliary acute pancreatitis. In mild disease, this is performed safely within 7 days, whereas in severe disease, especially in extended pancreatic necrosis, at least 3 weeks should elapse because of an increased infection risk.

Publication types

  • Review

MeSH terms

  • Acute Disease
  • Adult
  • Aged
  • Aged, 80 and over
  • Cholangiopancreatography, Endoscopic Retrograde
  • Cholecystectomy, Laparoscopic / methods*
  • Cholelithiasis / diagnostic imaging
  • Cholelithiasis / surgery*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Pancreatitis / classification
  • Pancreatitis / diagnostic imaging
  • Pancreatitis / surgery*
  • Prospective Studies
  • Severity of Illness Index