Time of Biliary Surgery After Acute Pancreatitis Due to Biliary Disease

Abstract

The timing of corrective biliary surgery, after an episode of acute pancreatitis due to biliary disease, is a concern to surgeons. Acute pancreatitis frequently results from biliary disease, and it is wise to avoid operative manipulation in this area until the pancreatitis has subsided. In most patients the acute symptoms will promptly subside under medical treatment with nasogastric suction, anticholinergic drugs, replacement of fluid, antibiotics (when indicated), and medication for pain. The surgeon, having identified the presence of coexisting biliary and pancreatic inflammation, must decide on the appropriate time for cholecystectomy or biliary exploration. For the few patients in whom the acute symptoms do not subside, or in whom they worsen, the surgeon must weigh the risks of continued medical therapy against those of immediate operation. In many patients the pancreatitis is so mild as to be only suspected from an increase in the serum amylase content during an episode