Acute gallstone pancreatitis: best timing for biliary surgery.

The timing of biliary surgery in patients who have pancreatitis secondary to cholelithiasis is debatable. Of 523 patients admitted for acute pancreatitis between 1969 and 1978, 114 had gallstones for which an operation was performed, early and late operation respectively in 98 patients. Complications occurred in 12 of the 114 patients and 7 patients died. Significantly more deaths occurred in the group who had an immediate operation (n = 5). In the group who had an operation more than 7 days after the amylase returned to normal, recurrent pancreatitis developed in 5 patients, 1 of whom died. It is concluded that immediate operation does increase mortality, and so may delay longer than 7 days after the amylase returned to normal.