ERCP's Role in the Management of Acute Biliary-pancreatic Pathology in the Laparoscopic Era
نویسندگان
چکیده
OBJECTIVES Laparoscopic cholecystectomy (LC) combined with endoscopic retrograde cholangiopancreatography (ERCP) has been widely used in the management of the acute biliopancreatic pathology. Nevertheless, controversy remains about the appropriate timing for retrograde cholangiopancreatography. METHODS A retrospective study was undertaken on a consecutive series of 117 patients with acute biliary-pancreatic pathology, who underwent laparoscopic cholecystectomy between April 1995 and April 1999. Criteria for preoperative endoscopic retrograde cholangiopancreatography were defined, and the patients were divided into 3 groups based on the presence or absence of a preoperative retrograde cholangiopancreatography indication: (1) ERCP+LC group: patients with retrograde cholangiopancreatography indicated and performed (n = 30); (2) LC group: patients without retrograde cholangiopancreatography criteria treated only by LC (n = 47); (3) LC-ERCP group: patients with retrograde cholangiopancreatography criteria but not performed (n = 40). RESULTS The groups were similar in age, sex, ASA, and clinical diagnosis. No statistical differences occurred in operative times (73.8 min, 68 min, 67 min), major complications (3.3%, 4.25%, 12.5%), and mean postoperative stay (3.7 +/- 4; 4.7 +/- 2; 5.7 +/- 2). Postoperative retrograde cholangiopancreatography had to be used, respectively, in 0%, 10.6%, and 7.5%. The best predictive criteria for common bile duct pathology were choledocholithiasis on an ultrasound scan and the presence of cholangitis. The other criteria tested had a low predictive value. CONCLUSIONS Preoperative endoscopic retrograde cholangiopancreatography followed by early laparoscopic cholecystectomy can be performed safely in acute biliary-pancreatic pathology, avoiding 2-stage treatment of these patients and minimizing hospital stay and inconvenience to the patients. Nevertheless, this therapeutic/diagnostic tool must be used selectively.
منابع مشابه
Effect of Diclofenac Suppository on Treatment of Acute Biliary Pancreatitis
Background and Aim: Acute pancreatitis is an inflammatory pancreatic disease that is associated with low or no fibrosis of the pancreas. Standard non-surgical treatment in all patients involves correcting water and electrolyte disorders, pain relief and avoiding pancreatic secretion. Given that pancreatitis is an inflammatory process, and NSAIDs have been shown to modulate inflammatory processe...
متن کاملManagement of Biloma due to Biliary Tract Injury after Laparoscopic Cholecystectomy in a patient with Atypical Anatomy: A Case Report
Introduction: Biliary tract injury is a major complication of laparoscopic cholecystectomywhich can be very challenging. But, the important part is to know the accurate anatomy of the ducts and site of the injury before any surgical attempt for ligation or repair. In this case a disaster might happ...
متن کاملSurgical treatment of patients with acute cholecystitis: Tokyo Guidelines
Cholecystectomy has been widely performed in the treatment of acute cholecystitis, and laparoscopic cholecystectomy has been increasingly adopted as the method of surgery over the past 15 years. Despite the success of laparoscopic cholecystectomy as an elective treatment for symptomatic gallstones, acute cholecystitis was initially considered a contraindication for laparoscopic cholecystectomy....
متن کاملDoes it require to exclude cardiobiliary reflex in every acute coronary syndrome follow up patient with bedside ultrasound on emergency department
In emergency department, physicians can diagnose pulseless electrical activity, asystole, pericardial effusions, ischemic heart disease, wall motion abnormalities, valvular cardiac disease volume status or global cardiac function evaluating with electrocardiographic findings or using bedside c...
متن کاملJPN Guidelines for the management of acute pancreatitis: treatment of gallstone-induced acute pancreatitis
Gallstones, along with alcohol, are one of the primary etiological factors of acute pancreatitis, and knowledge of the etiology as well as the diagnosis and management of gallstones, is crucial for managing acute pancreatitis. Because of this, evidence regarding the management of gallstone-induced pancreatitis in Japan was collected, and recommendation levels were established by comparing curre...
متن کامل