Active surgical strategy in gallstone pancreatitis complicated with cholangitis

Abstract

Aims: Acute cholangitis is critical condition in patients with gallstone pancreatitis. The aim of the study was assessment of preoperative risk and surgical strategy in patients with gallstone pancreatitis complicated with acute cholangitis and jaundice. Methods: Totally 102 patients with gallstone pancreatitis were treated in our institution during the period from November 2013 to November 2014 and were stratified according to the presence (group1) or absence (group2) of cholangitis. Main variables for statistical analysis were American society of anaesthesiologists (ASA) score; concentration of lipase, bilirubin, C-reactive protein (CRP) and procalcitonin (PCT). Time of preoperative preparation, type of surgical intervention, application of intra-operative ultrasound and main outcomes were analysed in both groups. Results: 41 patient were enrolled in group1 and 61 patient in group2. ASA grade IV comorbidities were observed more often in group1, p = 0.02, without difference in incidence of severe forms of acute pancreatitis according to the revised Atlanta classification. Patients in group1 had significant prevalence of choledocholithiasis and microlithiasis, jaundice and incidence of sepsis, p < 0.001. Maximal activity of the lipase was not different median of 3563.5U/Le4395U/L, respectively. Significantly higher maximal bilirubin level, p < 0.01; CRP on day 1-3 and maximal CRP, p = 0.012, 0.08, 0.014; higher PCT, p = 0.039, 0.007, 0.031 characterised inflammatory response in group1, without difference preoperatively. Similar rate of surgical interventions, median of 7 days before surgical intervention and frequency of intraoperative ultrasonography in 56% to 72% of patients were observed in both groups. Laparoscopic surgery was performed in 63%-67%, ERCP was done in less than 7% of patients. Median hospital stay was 12-11 days, median ICU stay 2- 4 days without statistical difference compared groups. Mortality in group1 was 4.9%, with zero mortality in group2. Conclusions: Active surgical strategy is effective in patients with gallstone pancreatitis even when comorbid conditions and presence of cholangitis and sepsis complicates clinical course of the disease.