The role of ERCP and laparoscopic cholecystectomy in gallstone-related pancreatitis

Summary

Laparoscopic surgery has become the routine for elective cholecystectomy, but its place in the management of gallstone-related pancreatitis has not yet been identified. We prospectively assessed a minimally invasive treatment regime for gallstone pancreatitis combining endoscopic retrograde cholangiopancreatography (ERCP) and laparoscopic cholecystectomy, over a 24 month period. Twenty-two patients were found to have gallstone pancreatitis. The mean age was 52 ± 18 years. All patients presented with abdominal pain. Five were jaundiced. The Ranson score severity of pancreatitis averaged 1.6 (range 0–6). Our management protocol was to perform ERCP when clinical and biochemical markers had settled, followed by laparoscopic cholecystectomy during the same admission. The time interval between presentation and ERCP was 8.9d (range 2–15d), ERCP to surgery was 4.5d (range 2–35d) and surgery to discharge was 4d (range 1–21 d). The median hospital stay was 16d. ERCP showed stones in the common bile duct in five patients, four of whom had them removed at ERCP. Twenty patients underwent laparoscopy. The gallbladder was removed in 18 and two required conversion (one pseudocyst, one cystic artery bleed). Two patients had elective open cholecystectomy (one pseudocyst, one previous surgery). Only one patient developed a post-operative complication (pseudocyst). The majority of patients had multiple small stones in their gallbladder and it was not possible to predict the presence of common bile duct stones prior to ERCP. No patient developed post-operative pancreatitis. There was no mortality. This study shows that combined ERCP and laparoscopic cholecystectomy is an efficient and safe minimally invasive management for gallstone pancreatitis.