Early Percutaneous Transhepatic Gallbladder Drainage Compared With Surgical Operation In Acute Biliary Pancreatitis

ABBREVIATIONS: Acute Biliary Pancreatitis (ABP); Common Bile Duct(CBD); Gallbladder (GB); Endoscopic Nasobiliary Drainage (ENBD); EndoscopicRetrograde Cholangiopancreatography (ERCP); Endoscopic Sphincterotomy (EST);Digital Subtraction Angiography(DSA).Background/Aims: To compare between early percutaneous transhepaticgallbladder drainage within72hours after the onset of pain with conservativemanagement followed by surgical operation in acute biliary pancreatitis.Methodology: Sixty three cases of Acute Biliary Pancreatitis cases were includedin this study which was composed of33males and30females, aged23-74years with amean age of52-years. From October2009to October2011, randomly four cases withgallbladder originating out of sixty three patients having mild to moderate severitywhich was evaluated by Ranson, APACHE II, and CT score respectively underwentearly percutaneous transhepatic gallbladder drainage compared with randomly six casesgallbladder originating out of sixty three patients who were chosen receivedconservative management followed by surgical operation. In this study, patients werecategorized with some criteria to estimate the effectiveness by recording the number ofdays: of the oral administration, tube removal, bowel open, abdominal paindisappearance, clinical signs disappearance, urinary amylase returning to normal,antibiotics taken and length of hospital stay.Results:In the first group (n=4,1male and3females), early percutaneous transhepaticgallbladder drainage was performed in patient with mild to moderate ABP within72hrsin4out of64patients,3being successful and1patient needed an elective laparoscopicsurgery since recurrence of signs after21weeks with no mortality occurred. In second group (n=6,2males and4females), where patients underwent surgery, six hadcholecystectomy surgery. The overall rate of complications was similar in the twogroups, the incidence of local complication and systemic complication were no majordifferences. The prognosis between the two groups was satisfactory. By comparing theresults between the groups, there was a statistically significant in the number of days forthe disappearance of clinical signs; t(8)=2.569P=0.033, antibiotics consumption;t(8)=2.956P=0.018and hospitalization; t(8)=2.495P=0.037.Conclusions: The results showed that early DSA-guided percutaneous transhepaticgallbladder drainage is a simple, time saving and cost effective procedure with mild tomoderate severity of ABP patients. It may deserve to become a definitive therapy forsubsequent surgical management. Larger controlled studies are needed to furtherconfirm our findings.