Mild to Moderate Acute Biliary Pancreatitis; Frequency of Conversion from Laparoscopic to Open Cholecystectomy in Early versus Delayed Surgery

.. Introduction: Acute biliary pancreatitis is a serious complication of biliary calculous disease and is associated with significant morbidity and mortality. Incidence is more often in females and cause is the gall stones in majority of the cases. Definitive treatment is cholecystectomy and with the advancement of minimal invasive surgery, laparoscopic cholecystectomy has been considered as a gold standard for the management of acute Biliary Pancreatitis. The optimal timing when to perform laparoscopic cholecystectomy is still under debate. Many surgeons recommend early surgery whereas others are in favor of delayed surgery. This study is carried out to compare the timing of laparoscopic cholecystectomy in cases of acute biliary pancreatitis. Objective: To compare the frequency of conversion from laparoscopic to open cholecystectomy in early versus delayed laparoscopic cholecystectomy in mild to moderate acute biliary pancreatitis. Study design: Randomised Control trial (RCT). Setting: Department of surgery, Holy Family Hospital, Rawalpindi. Duration: Six months, from January 2010 to June 2012. Material and methods: 306 patients, diagnosed as mild to moderate acute Biliary Pancreatitis were randomly allocated into two groups for laparoscopic cholecystectomy. Those who were operated within two weeks of index hospital admission were labeled as Early laparoscopic cholecystectomy (EC) group whereas those undergoing surgery after 02 weeks of index hospital admission were considered as Delayed laparoscopic cholecystectomy group(DC). Conversion rate from laparoscopic to open cholecystectomy was compared in two groups. Results: Out of 153 patients enrolled as EC group, 138 were female and 15 were male patients. Mean age was 39.19 ± 11.25years where as in DC group , there were 134 female and 19 male patients in a total of 153 patients, and the mean age was 39.54 ±10.37 years. Conversion from laparoscopic surgery to open cholecystectomy was 8.5%(13 patients) and 13.1%(20 patients) in EC and DC groups respectively. The overall conversion rate was 10.8%. There was no statistical significance between conversion rate of the two groups. (p = 0.197) Conclusions: Acute Biliary Pancreatitis should be managed by laparoscopic cholecystectomy regardless of the time elapsed since the start of symptoms. There is no statistical significance of conversion rate from laparoscopic to open cholecystectomy associated with the timing of surgical intervention in the case of acute Biliary Pancreatitis.