Abstracts Accepted by Title

During the last 12 years (Jan.1978 to Dec 1989) at the surgical department of our Institution 2220 patients were operated for gallsto-. ne desease of the biliary system.Among then 224 patients (10.09%) were operated and had gallstone acute pancreatitis (AP).Cholelithiasis and AP were documented in all patients by operation,clinical, x-rays and biochemical findings.Of the 224 patients in 47 the operation was done early and without improvement of their AP.This was done into the first week of their treatment (group A patients).In this group of patients the operation was done as a urgent procedure and it was also for the definitive treatment of their gallstone desease (i .e. cholecystectomy,choledochotomy usual ly,necrosectomydebridement of the necrotic pancreatic and peripancreatic tissue in some patients and multiple external drainage to all of the patients. In many of them the diagnosis for the first time was put during laparatomy.The laparatomy was done with the misdiagnosis of acute cholecystitis,perforated peptic ulcer or mesenteric infarction.ln this group A of patients we had 9 deaths and the mortality rate was 19%. One hundred and senenty seven patients were operated for their bil iary desease ellecti.vely,after the crisis of AP had subsided with the conservative treatment.Usually this group of patients (group B), was operated at the sameadmission to the Ho.spital and around the 15th day from the onset of the symptoms.ln these group of patients we had no deaths (mortality 0%). The timing of biliary surgery remains controversial in patients with acute panreatitis associated with cholelithiasis.We usually operate on these patients after the 15th day since the onset of their symptoms and always at the same admission to the Hospital .When there is no improvement with the conservative treatment of acute pancreatitis and when the diagnosis is put for the first time during laparatomy, we conclude in this parer,that the definitive surgery for the lithiasis of the biliary tract must be done at the same time.This technicaly has not difficulties for the experienced surgeon,does not adds to the complications and mortality,saves the patient by a second operation and protects him of recurrences of AP during the waitti ng time.