Efficiency of the early surgery in acute biliary pancreatitis
Keywords:acute biliary pancreatitis, laparoscopic cholecystectomy, endoscopic papillotomy, complications
AbstractBackground. The evaluation of the effectiveness of active surgical tactics in patients with acute biliary pancreatitis was the purpose of our study. Materials and methods. A clinical examination and treatment of 126 patients with acute biliary pancreatitis has been performed. Among the examined patients, there were 32 men (25.4 %), and 94 women (74.6 %). Based on the causes of acute biliary pancreatitis, we identified three groups of patients: the first one — 65 individuals with isolated cholecystolithiasis (42 — with acute calculous cholecystitis, 23 — with chronic calculous cholecystitis), the second one — 35 patients with small concrements in different departments of the biliary tract, which did not cause obturation of the common bile duct, and the third one — 26 persons, who had torsion concretions of the common bile duct, including those wedged into major duodenal papilla. Patients in the first group underwent laparoscopic cholecystectomy, in the second and third groups — endoscopic transpapillary decompression of the common bile duct and, if necessary, laparoscopic cholecystectomy. In up to 48 hours, surgeries were performed in 78.6 % of patients in all groups. Results. During the analysis, it was found that the temperature response in patients, who were operated for 48 hours, was normal within 2.2 ± 0.8 days, whereas in patients, who had surgical intervention at a later date, — after 3.0 ± 0.7 days. Early operative intervention in all groups of patients positively influenced the regression of clinical signs of acute biliary pancreatitis and paralytic intestinal obstruction. Active surgical tactics allowed to reliably eliminate respiratory (p = 0.01; odds ratio (OR) = 4.0); hemodynamic (p = 0.02; OR = 5.69); enteral (p = 0.04; OR = 3.50) syndromes, systemic inflammation response syndrome (p = 0.04; OR = 3.50) and an increased level of enzymes in the blood (p = 0.07; OR = 4.79). We had not found significant differences in regression of clinical and laboratory manifestations of peritoneal (p = 0.6; OR = 1.74), metabolic (p = 0.3; OR = 2.29), hemocoagulation (p = 0.8; OR = 1.24) and liver syndrome (p = 0.1; OR = 2.54) and renal (p = 0.3; OR = 2.02) dysfunction, depending on the terms of the operation. Also, these patients noted a lower incidence of specific complications of acute biliary pancreatitis: acute peripancreatic uninfected fluid clusters (p = 0.03; OR = 0.15), peripancreatic abscesses, postnecrotic cysts of the pancreas (p = 0.05; OR = 0.18) and postcholecystectomy syndrome (p = 0.05; OR = 0.27). Conclusions. In patients with acute biliary pancreatitis, surgery on the bile duct system for up to 48 hours can significantly improve the regression of the main clinical manifestations of the disease, is pathogenetically substantiated and should be used more frequently.
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