Gallstone pancreatitis: the second time around.

Over a 16-year period from 1965 to 1981, 35 patients who had undergone previous operation for gallstone pancreatitis were treated by us because of retained or recurrent common bile duct stones. The recurrence rate of gallstone pancreatitis in this study, after "the first time around," was 92%. The interval between the initial operation and the recurrent attack of gallstone pancreatitis ranged from 1 month to 30 years. The mean interval was 2 years for patients with retained stones and 12 years for patients with recurrent stones. There were stones present in 83% of the common bile ducts, 23% of which were impacted at the ampulla of Vater. Thirty-seven percent of the patients passed stones in the stool measuring up to 8 mm in size. Of the patients who had early operation, 66% had impacted ampullary stones, but only 18% of patients who underwent delayed surgery had such stones. The recurrence of gallstone pancreatitis, "the second time around," was only 2%. The data attest to the facts that (1) the natural history of a retained or recurrent common bile duct stone in a patient previously operated on for gallstone pancreatitis is recurrence of the disease, and (2) absolute stone clearance of the common bile duct the first time around will cure virtually all the patients. Further support for the "migratory theory" of gallstone pancreatitis is substantiated by this study.