MILD TO MODERATE ACUTE BILIARY PANCREATITIS;

FREQUENCY OF CONVERSION FROM LAPAROSCOPIC TO OPEN CHOLECYSTECTOMY IN EARLY VERSUS DELAYED SURGERY

Abstract

Introduction: Acute biliary pancreatitis is a serious complication of biliary
calculous disease and is associated with significant morbidity and mortality. Incidence is more
often in females and cause is the gall stones in majority of the cases. Definitive treatment is
cholecystectomy and with the advancement of minimal invasive surgery, laparoscopic
cholecystectomy has been considered as a gold standard for the management of acute Biliary
Pancreatitis. The optimal timing when to perform laparoscopic cholecystectomy is still under
debate. Many surgeons recommend early surgery whereas others are in favor of delayed
surgery. This study is carried out to compare the timing of laparoscopic cholecystectomy in cases
of acute biliary pancreatitis. Objective: To compare the frequency of conversion from
laparoscopic to open cholecystectomy in early versus delayed laparoscopic cholecystectomy in
mild to moderate acute biliary pancreatitis. Study design: Randomised Control trial (RCT).
Setting: Department of surgery, Holy Family Hospital, Rawalpindi. Duration: Six months, from
January 2010 to June 2012. Material and methods: 306 patients, diagnosed as mild to
moderate acute Biliary Pancreatitis were randomly allocated into two groups for laparoscopic
cholecystectomy. Those who were operated within two weeks of index hospital admission were
labeled as Early laparoscopic cholecystectomy (EC) group whereas those undergoing surgery
after 02 weeks of index hospital admission were considered as Delayed laparoscopic
cholecystectomy group(DC). Conversion rate from laparoscopic to open cholecystectomy was
compared in two groups. Results: Out of 153 patients enrolled as EC group, 138 were female and
15 were male patients. Mean age was 39.19 ± 11.25years where as in DC group , there were 134
female and 19 male patients in a total of 153 patients, and the mean age was 39.54 ±10.37 years.
Conversion from laparoscopic surgery to open cholecystectomy was 8.5%(13 patients) and
13.1%(20 patients) in EC and DC groups respectively. The overall conversion rate was 10.8%.
There was no statistical significance between conversion rate of the two groups. (p = 0.197)
Conclusions: Acute Biliary Pancreatitis should be managed by laparoscopic cholecystectomy
regardless of the time elapsed since the start of symptoms. There is no statistical significance of
conversion rate from laparoscopic to open cholecystectomy associated with the timing of
surgical intervention in the case of acute Biliary Pancreatitis.