Timing of Laparoscopic Cholecystectomy After Endoscopic Retrograde Cholangiography for Acute Biliary Pancreatitis
Timing of Laparoscopic Cholecystectomy After Endoscopic Retrograde Cholangiography for Acute Biliary Pancreatitis
Timing of laparoscopic cholecystectomy following after endoscopic retrograde cholangiography
 for acute biliary pancreatitis is a controversial issue. There are still many confounding
 findings offering either early laparoscopic cholecystectomy within 72 hours following
 endoscopic sphincterotomy or delayed surgery after 6 weeks. Peritoneal plasmin system is
 known to be an important factor in peritoneal healing and adhesion formation. Measurement of
 tissue concentrations of tissue-type plasminogen activator and its specific activity,
 urokinase-type plasminogen activator, and plasminogen activator inhibitor type 1 are thought
 to be helpful to show peritoneal adhesions after endoscopic sphincterotomy.
Peritoneal fibrinolysis is crucial in peritoneal healing processes and subsequent adhesion
 formation. It is expected that endoscopic retrograde cholangiography is a trauma causing
 adhesions around the hepatobiliary area. Such adhesions may cause some difficulty for
 consequent gallbladder surgery. For that reason, tissue measurements of factors indicating
 degree of peritoneal healing and adhesion is helpful for timing of such surgical
 interventions.

 Patients are going to be randomized to early and delayed surgery groups. Sampling of
 peritoneum around the gallbladder during laparoscopic cholecystectomy in patients after
 endoscopic retrograde cholangiography is performed. Tissue concentrations of tissue-type
 plasminogen activator and its specific activity, urokinase-type plasminogen activator, and
 plasminogen activator inhibitor type 1 are going to be studied by using commercial assays.

 Peritoneal fibrinolytic activity and surgical outcomes are going to be compared.
Inclusion Criteria:

 -  cholelithiasis following endoscopic retrograde cholangiography for acute biliary
 pancreatitis

 Exclusion Criteria:

 -  contraindication to laparoscopy

 -  unsuccessful endoscopic retrograde cholangiography

 -  complicated acute biliary pancreatitis