Abstract
Laparoscopic Cholecystectomy is an essential part of treatment of so called pancreatitis. It seems a necessary but not sufficient therapeutical act as demonstrated by the biliary still high incidence of post-cholecystectomy pancreatitis. There is no means of knowing which patient affected by biliary pancreatitis with no diagnosable abnormalities of the biliary main tract will develop a recurrent pancreatitis. This study supports the concept that by adding a “clearance” of the biliary tact at the cholecystectomy (so called rendezvous technique), a prevention of recurrent pancreatitis can be obtained. This observational study includes 39 hospitalized patients suffering from an acute biliary pancreatitis episode. None of them had serum bilirubin elevation or jaundice, and 27 had no instrumental evidence of bile duct obstruction while 12 had minor stones in the main bile duct. Rendezvous technique revealed undiagnosed bile duct abnormalities either functional or organic in 13 cases. During a 5 years follow-up period after the procedure no recurrent pancreatitis were observed. Our experience has shown that the technique of Rendezvous can reveal and treat obstructions of the bile duct that have not been diagnosed with instrumental examinations; furthermore, this technique seems to prevent the development of recurrent acute pancreatitis.
Highlights
Laparoscopic Cholecystectomy is considered as an essential part of treatment of acute pancreatitis in cases labelled as affected by “acute biliary pancreatitis (ABP)” [1,2]
video laparoscopic cholecystectomy (VLC) phase In three cases the laparoscopic procedure was converted into open surgery: in one case a big hiatal ernia and partial pancreas necrosis were found; in one case severe adhesions from previous surgery forced to open surgery; in one case a pre-existing pancreatic abscess from pancreatitis was found and drained via open technique
The so called “target cholecystectomy” represents an efficient option for the treatment of acute biliary pancreatitis whenever ABP gallstones are associated with bile duct stones, both VLC and ERCP are mandatory, the timing and sequence of the two procedures are still debated [9]
Summary
Laparoscopic Cholecystectomy is considered as an essential part of treatment of acute pancreatitis in cases labelled as affected by “acute biliary pancreatitis (ABP)” [1,2]. Appropriate timing of video laparoscopic cholecystectomy (VLC) is estimated to minimize the risk of recurrent pancreatitis [3] during the waiting time for operation. The incidence of Recurrent Acute Pancreatitis after cholecystectomy still reaches high incidences (up to 17%) [4]. There is no means to foresee which patient among those affected by biliary pancreatitis will need a bile duct clearance after the cholecystectomy. Known causes of recurrent ABP are choledocholithiasis, alteration of Wirsung duct, and papillar dysfunction [7] among those the only which can be diagnosed is choledocholithiasis, classically treated by ERCP either before, together, or after VLC. For the other two conditions, frequently encountered during ERCP, diagnosis is hard, and could at least partially explain the incidence of recurrent AP after VLC
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