Timing of surgery for acute gallstone pancreatitis

Abstract

One hundred four consecutive patients with acute gallstone pancreatitis underwent biliary surgery. The relationships between the timing of surgery, the severity of pancreatitis, and the surgical outcome were examined. Patients were divided into three groups according to the timing of surgery and into four groups according to the gross pancreatic pathologic characteristics observed at operation. Patients who underwent surgery early tended to have a higher incidence of common bile duct stones and more severe forms of pancreatitis; however, neither the timing of surgery nor the severity of pancreatitis had a significant impact on surgical outcome. Other factors, such as the level of serum amylase on admission and presence or absence of choledocholithiasis, did not significantly influence the natural history of the disease or the outcome of surgical therapy, whereas advanced age was associated with higher morbidity. Hemodynamic status and the overall condition of the patients were more important than either the timing of surgery or the gross pathologic characteristics of the pancreas in determining surgical outcome. We conclude that the timing of surgery is not a critical factor in the outcome of surgery for acute gallstone pancreatitis. Provided that the patient is stable and has no medical contraindications, surgery on the biliary tract can be performed safely at any time after initial resuscitation of the patient and confirmation of diagnosis.