Acute Pancreatitis After Laparoscopic Transcystic Common Bile Duct Exploration: An Analysis of Predisposing Factors in 447 Patients

IntroductionIn laparoscopic transcystic common bile duct exploration (LTCBDE), the risk of acute pancreatitis (AP) is well recognized. The present study assesses the incidence, risk factors, and clinical impact of AP in patients with choledocholithiasis treated with LTCBDE.MethodsA retrospective database was completed including patients who underwent LTCBDE between 2007 and 2017. Univariate and multivariate analyses were performed by logistic regression.ResultsAfter exclusion criteria, 447 patients were identified. There were 70 patients (15.7%) who showed post-procedure hyperamylasemia, including 20 patients (4.5%) who developed post-LTCBDE AP. Of these, 19 were edematous and one was a necrotizing pancreatitis. Patients with post-LTCBDE AP were statistically more likely to have leukocytosis (p<0.004) and jaundice (p=0.019) before surgery and longer operative times (OT, p<0.001); they were less likely to have incidental intraoperative diagnosis (p=0.031) or to have biliary colic as the reason for surgery (p=0.031). In the final multivariate model, leukocytosis (p=0.013) and OT (p<0.001) remained significant predictors for AP. Mean postoperative hospital stay (HS) was significantly longer in AP group (p<0.001).ConclusionThe risk of AP is moderate and should be considered in patients with preoperative leukocytosis and jaundice and exposed to longer OT. AP has a strong impact on postoperative HS.