Ahmad Mirza, Haitham Qandeel, Samer Zino, Ahmad Nassar. Monklands District General Hospital, Airdrie, United Kingdom
The surgical management of acute gallstone pancreatitis (AGSP) in the elderly is a challenging clinical situation. Our aim was to assess single-session laparoscopic management of acute gallstone pancreatitis in patients ≥ 70 years.
We collected data prospectively for patients undergoing laparoscopic biliary surgery over 20 years (N=4408) was analysed. We reviewed the data for patients aged ≥ 70 years diagnosed and underwent surgical management for.
A total of 46 patients were identified. The mean age was 75 years. 75% were females. 97% were emergency admissions, and 53% were jaundiced. ASA score was 2 in 46% and 3 in 37%. Initial conservative management was followed by surgery in the majority according to the local protocol. MRCP was requested in three cases and only two patients underwent pre-operative ERCP. We perform intra-operative cholangiography routinely. Common bile duct stones were identified in 14 cases (30%); all extracted laparoscopically. The mean surgical time was 65 mins (20 to 195 mins). The average inpatient hospital stay was 7 days (range 2 to 46 days). All but one patient were treated during the index admission. There were no post-operative complications, readmissions or deaths.
Single session management of acute pancreatitis in the elderly patients is preferable to and safer than staged management. Laparoscopic bile duct exploration can be performed when necessary, allowing optimal utilisation of resources such as MRCP and ERCP. It reduces hospital stay, number of admissions and presentation to resolution intervals.