Is ductal evaluation always necessary before or during surgery for biliary pancreatitis?

Abstract 

Background

Whether all patients undergoing cholecystectomy following an episode of biliary pancreatitis require direct common bile duct evaluation is controversial. We hypothesized such evaluation can be omitted safely among select patients at low risk for choledocholithiasis.

Methods

One hundred forty-eight patients undergoing cholecystectomy for biliary pancreatitis (January 1995–December 2005) met the following inclusion criteria: (1) no preoperative endoscopic retrograde cholangiography (ERC) or endoscopic retrograde cholangiopancreatography (ERCP); (2) normal or decreasing liver function tests (LFTs) preoperatively; and (3) no ductal dilation on non-invasive preoperative imaging. Group I had intraoperative cholangiography (IOC, n = 27); group II did not (n = 121).

Results

No differences between groups I and II were evident in postoperative retained-stone related events: recurrent pancreatitis (11% vs 8%, P = .7), cholangitis (0% in both groups), and asymptomatic LFT elevation (0% vs 3%, P > .99).

Conclusions

Direct ductal evaluation can be omitted safely in select patients undergoing cholecystectomy for biliary pancreatitis who are at low risk for choledocholithiasis.

Keywords: Biliary pancreatitis, Intraoperative cholangiography, Cholecystectomy, Choledocholithiasis