The aetiology and prevention of pancreatitis following biliary-tract operations

Abstract

The incidence of pancreatitis complicating biliarytract operations is reported from a prospective survey of 75 patients. This study confirms that pancreatitis is much more frequent after choledochotomy than after cholecystectomy alone. Biochemical pancreatitis was demonstrated in over a third of the patients in whom the duct was explored. The validity of elevated serum amylase in the diagnosis of this complication is established provided that clinical evidence of pancreatitis is also present. The significance of amylasaemia in the immediate postoperative period in the absence of clinical signs is questioned. Reflux of duodenal contents into the pancreatic duct may be provoked by operative damage to the sphincter of Oddi. In these patients clinical pancreatitis invariably occurred. The avoidance of sphincterotomy in the prevention of this potentially serious postoperative complication is advised. Since pancreatitis was more common after negative exploration of the common bile-duct the value of operative cholangiography in the avoidance of this complication is discussed.