Biliary pancreatitis. Operative outcome with a selective approach
W. H. Schwesinger, C. P. Page, K. R. Sirinek, B. A. Levine and J. B. Aust
Department of Surgery, University of Texas Health Science Center (UTHSC), San Antonio 78284-7842.
To evaluate the efficacy of a selective approach to biliary pancreatitis,
we reviewed the outcomes in 276 consecutive patients undergoing operations
for this diagnosis during a 7-year period. Initial conservative therapy
resulted in elective operations in 63% and urgent operations in 37%. Only
10 patients (3.6%) required primary pancreatic operations, 50% of them as
emergencies. The proportion of common duct surgical explorations fell from
70% of those operated immediately after hospital admission to 20% by the
third hospital day. Overall mortality was 1.8% but was increased to 30% in
patients having an initial pancreatic operation. We conclude that a
selective approach to biliary pancreatitis allows the operation to be
performed electively in most patients and is associated with a low
mortality and an acceptable length of stay. Most common duct stones pass
spontaneously permitting cholecystectomy alone.
