Outcome after surgery for biliary pancreatitis.

OBJECTIVE

To correlate the results of operations for the treatment of biliary pancreatitis with the timing of the operation.

DESIGN

Retrospective study.

SETTING

University hospital, Germany.

SUBJECTS

81 Consecutive patients who were operated on for biliary pancreatitis of the 106 who presented to the department between 1981 and 1990.

INTERVENTIONS

Cholecystectomy, with or without exploration of the common duct, together with no operation on the pancreas, exploration, or drainage and necrosectomy.

MAIN OUTCOME MEASURES

Correlation of outcome with timing of operation after the onset of the pancreatitis (early, within 72 hours; delayed, 3-14 days; or elective, after 14 days).

RESULTS

37 Patients (46%) were operated on early; in 27 (33%) the operation was delayed; and in 17 (21%) it was elective. Timing correlated with outcome-22 patients (59%) of those operated on early developed a complication together with 12 (27%) of those in the delayed and elective groups (p < 0.005). The overall mortality was 12% (10/81). Multiple regression analysis showed that the timing of the operation and the severity of the pancreatitis were less important prognostic factors than the patient's age and the extent of pancreatitic operation (p < 0.005). The complication rate was 15/56 (27%) after none or exploration of the pancreas, compared with 19/25 (76%) after drainage or necrosectomy (p < 0.005).

CONCLUSION

Aggressive pancreatic surgery increases the risk of morbidity whereas extent of biliary surgery has no influence. Postponing the biliary operation until after the acute attack reduces the need for early exploration and drainage of the pancreas.