Safety of early cholecystectomy in acute biliary pancreatitis

Abstract

Introduction: Biliary stricture is a well-known complication of chronic pancreatitis which may require surgical drainage in the form of bilioenteric anastomosis. We report a novel technique for surgical management of such strictures -intrapancreatic choledochoplasty during Frey's procedure (FP), where we lay open the intrapancreatic CBD and fix it to the pancreatic tissue/capsule in the head to keep it patent. Methods: The study was carried out at a tertiary care centre in India from January 2017 to December 2019. Patients of chronic pancreatitis with associated biliary strictures who were candidates for FP were evaluated for suitability for the procedure. Strictures confined to the intrapancreatic CBD requiring biliary drainage underwent choledochoplasty in addition to FP. Results: 10 patients underwent choledochoplasty (8:2males:female). The mean age was 39 years. Pain was reported for a median duration of 36 months (6 -96 months) and jaundice for a median of 12 months (1 -36 months). 80% patients had at least one episode of cholangitis. Exocrine and endocrine insufficiency was present in 60% and 80% patients respectively. Preoperative stent was placed in the CBD/MPD in 40% patients each. Mean duration of surgery was 300 minutes and mean blood loss was 300 ml. The mean post-operative hospital stay was 8.5 days with no grade III -V complications. On followup, LFT was normal in all patients. Conclusions: We describe our technique of intrapancreatic choledochoplasty during FP, which is an effective substitute to bilioenteric anastomosis in surgical management of chronic pancreatitis induced intrapancreatic CBD strictures.