Gallstone pancreatitis. Support for a flexible approach.

We reviewed records of 63 patients with diagnosed gallstone pancreatitis. Most of them (89%) responded to nonoperative treatment. Nearly one quarter of patients undergoing operation 2.4 months later had a recurrent, uncomplicated episode of pancreatitis before the operation. Almost half of the patients who had early elective operations (9.7 days after admission) had common bile duct stones, compared with only 8% of those who underwent late elective operations. Eleven percent of patients had emergency operations during initial hospitalization because of failure to respond early to nonoperative treatment. Each of them had evidence of pancreatitis but also a potentially life-threatening and surgically curable disease. Although categoric emergency and elective operative approaches to patients with gallstone pancreatitis have been proposed, our study suggests that an absolute approach is neither necessary nor desirable.