| Safe laparoendoscopic approach to biliary pancreatitis in older patients. | |
| | |
MedLine Citation:
|
PMID: 8712905 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
OBJECTIVE: To evaluate management strategies for biliary pancreatitis in different age groups. DESIGN: Retrospective review. SETTING: Large private metropolitan teaching hospital. PATIENTS: Patients seen between January 1991 and December 1994 with a diagnosis of biliary pancreatitis (N = 136) divided into 2 groups (group 1, aged < 65 years; group 2, aged > or = 65 years). INTERVENTIONS: Primary treatments included endoscopic retrograde cholangiography (n = 36) alone or with endoscopic sphincterotomy (n = 27); operative procedures, including cholecystectomy by laparoscopic (n = 54) or open (n = 16) approaches; or no definitive therapy (n = 22). Secondary treatments of common bile duct stones included laparoscopic transcystic bile duct exploration (n = 5), open common bile duct exploration (n = 4), or postoperative endoscopic retrograde cholangiography (n = 10). MAIN OUTCOME MEASURES: Success of interventions, incidence and treatment of common bile duct stones, morbidity and mortality rates, frequency of retained stones, and length of hospitalization. RESULTS: Numbers of Ranson criteria were higher for older patients (group 1, 0.83 +/- 0.12 vs group 2, 1.57 +/- 0.11 [mean +/- SEM]; P < .001). Primary endoscopic retrograde cholangiography with or without endoscopic sphincterotomy was performed earlier than operative procedures, with a significantly higher incidence of common bile duct stones (72% vs 19%; P < .001). Number of primary procedures and complication and mortality rates for endoscopic retrograde cholangiography with or without endoscopic sphincterotomy were 36, 8%, and 3%, respectively; for laparoscopic cholecystectomy, 54, 9%, and 2%, respectively; and for open cholecystectomy, 16, 6%, and 19%, respectively. For complication and mortality rates, there were no statistical differences between groups or among treatments. Deferred therapy was used in 30 patients, with 20% readmitted for recurrence of biliary pancreatitis. Length of intensive care unit and total hospital stay were similar for all groups and treatments. CONCLUSIONS: Older patients with biliary pancreatitis may be safely treated with a combined laparoendoscopic approach. Management of common bile duct stones depends on age, with laparoscopic transcystic duct exploration or open common bile duct exploration preferred for younger patients and laparoscopic transcystic duct exploration or postoperative endoscopic sphincterotomy for older ones. Deferred therapy has a substantial relapse rate. |
| | |
Authors:
|
M F McGrath; J C McGrath; J Gabbay; E H Phillips; J R Hiatt |
Related Documents
:
|
7749705 - Peroperative endoscopic sphincterotomy during laparoscopic cholecystectomy for choledoc... 7552015 - Prospective evaluation in 121 consecutive unselected patients undergoing laparoscopic t... 16738995 - Postoperative management of noniatrogenic traumatic bile duct injuries: role of endosco... 9378205 - Benefits and risks of needle-knife papillotomy. 23408585 - Robotic anderson-hynes dismembered pyeloplasty: initial experience. 20195955 - air embolisation during vitrectomy? |
Publication Detail:
|
Type: Journal Article; Review |
Journal Detail:
|
Title: Archives of surgery (Chicago, Ill. : 1960) Volume: 131 ISSN: 0004-0010 ISO Abbreviation: Arch Surg Publication Date: 1996 Aug |
Date Detail:
|
Created Date: 1996-09-09 Completed Date: 1996-09-09 Revised Date: 2005-11-16 |
Medline Journal Info:
|
Nlm Unique ID: 9716528 Medline TA: Arch Surg Country: UNITED STATES |
Other Details:
|
Languages: eng Pagination: 826-31; discussion 831-3 Citation Subset: AIM; IM |
Affiliation:
|
Department of Surgery, Cedars-Sinai Research Institute, Cedars-Sinai Medical Center, Los Angeles, USA. |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Adolescent Adult Age Factors Aged Aged, 80 and over Algorithms Cholangiopancreatography, Endoscopic Retrograde / adverse effects, methods* Cholecystectomy, Laparoscopic / adverse effects, methods* Female Gallstones / complications* Humans Male Middle Aged Pancreatitis / etiology, surgery* Retrospective Studies Sphincterotomy, Endoscopic / adverse effects, methods* Treatment Outcome |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: The role of neoadjuvant therapy in surgically resectable esophageal cancer.
Next Document: Left-upper-quadrant devascularization for 'unshuntable' portal hypertension.