Presentation and Outcome of Gall Stone Pancreatitis in A Tertiary Care Center in North India

Abstract

Background: A prospective study to evaluate the clinical presentation of acute gallstone pancreatitis and to assess the feasibility and outcome of early elective laparoscopic cholecystectomy (LC) in these cases. Methods: Fifty four patients of gallstone pancreatitis were included in the study. The patients presenting in emergency were treated conservatively and were planned for early elective LC during the index admission after clinical improvement. Those who could not be operated during index admission were discharged with advice to come after 6 weeks for interval LC. Operative details, post-operative recovery and complications were recorded in all the cases and they were followed up to three months. Results: Out of 54 cases, 31 patients presenting with acute gallstone pancreatitis underwent early elective cholecystectomy during same admission (Group I). Twenty one patients admitted initially in emergency were treated conservatively and discharged with advice to come after 6 weeks for interval LC (Group II). However, majority of these patients were either readmitted in emergency with recurrence of acute gallstone pancreatitis (9/21, 43%) or never reported again (9/21, 43%). Only three of these 21 patients (4%) came for interval LC. Apart from these 21 cases, another two patients that were known case of biliary pancreatitis, also underwent elective LC and were included in Group II. Thus there were only five patients left in Group II undergoing interval elective LC. Most of the patients in both the groups were middle aged females (36/54, 67%) and presented with acute gallstone pancreatitis after 6 months of recurrent biliary colic (29/54, 93.5%). Based on CECT abdomen findings, most of the patients had mild gallstone pancreatitis (88%). Majority of the patients in both the groups underwent LC without any intraoperative complication. Post-operative complications, although negligible, were more in eight cases of severe gallstone pancreatitis. Conclusion: Majority of the patients present after multiple attacks of gallstone pancreatitis and early elective LC during index admission is a safe option in managing mild gallstone pancreatitis.