AISP - 36^th National Congress. Bologna, Italy. October 4-6, 2012

Severe Acute Biliary Pancreatitis: Mininvasive Approach

Pasquale De Biasio, Maria Concetta Gorgoglione, Alberto Fersini, Nicola Tartaglia, Antonio Ambrosi, Vincenzo Neri

General Surgery, Department of Medical and Surgical Sciences, University of Foggia. Foggia, Italy

Context Severe acute biliary pancreatitis is about 20% of all the pancreatitis. The relapse of the untreated cases is >20%. Objective The aim of the study is to define a mininvasive approach of the SABP: the maintenance of papillary patency and the treatment of the peripancreatic fluid gatherings and of the gallstones. Patients and Methods In the period 1999-2011, 60 severe acute biliary pancreatitis were treated: 42 necrotizing cases and 18 cases with pancreatic edema. All patients underwent ERCP/ES within 72 hours; it was successfully executed in 50 cases, in 7 cases it was delayed of 10 days, and it was non practicable in 3 cases. CT-scan guided percutaneous drainage was used for 3 infected peripancreatic and 2 intrahepatic gathering; another 2 infected gatherings were drained by laparotomic access. Cholecystectomy within 30 days: laparoscopic in 56 patients (93%). Results There were 4 post-ERCP pancreatitis (6.6%), failure of the procedure in 3 cases (5%) and no cholangitis, hemorrages or duodenal perforations; no morbidity for cholecystectomy neither for percutaneous drainage with resolution within 10 days. One patient (1.6%) died in 20^th day because of DIC. Conclusions The mininvasive approach of the severe acute biliary pancreatitis is an efficacious and safe therapeutic program with a long period of resolution (mean 35 days) but satisfying for the results.