Acute biliary pancreatitis: timing of the endoscopic sphincterotomy (ES) and of the videolaparocholecystectomy.

INTRODUCTION There is not uniformity in the literature about the timing of execution of the endoscopic sphincterotomy (ES) and later the videolaparocholecystectomy (VLC) in course of acute biliary pancreatitis (ABP): the aim of the study was to suggest the optimal timing. PATIENTS AND METHODS In the period September 1997-November 2004, 67 patients were treated for ABP. Fifteen cases were severe ABP and 52 were mild ABP. In 55 patients an ES was executed within 48-72 hours; in 12 cases the ES was delayed of 10 days. After 8-10 days, 62 patients had a VLC; 5 patients had an open cholecystectomy. RESULTS The coledochal stone was removed in 32 cases (47.7%); in the last 35 patients (52.3%) the biliary sand or sludge was removed. Immediate results: 1 case (1.5%) of pancreatitis reacutizzation, 6 cases (9.8%) increase of the lypase and amylase, 2 (2.9%) duodenal perforations. The cholecystectomy, laparoscopic and open, did not have relevant complications. Later in time we have registered the develop of 3 postnecrotic pancreatic pseudocysts, treated with surgical therapy. CONCLUSIONS The ES in course of severe and mild ABP has the double goal to clean the principal biliary duct by the stones, and moreover to remove the papillar obstacle because of stenosis, biliary sand or sludge. In our experience, the golden therapeutic timing foresees the ES within 48-72 hours from the beginning of the symptomatology and the VLC within 8-10 days: this time is necessary to establish the absence the progression of the acute pancreatitis.