From the Research
There are no significant differences in perioperative outcomes despite the observed delay in time to surgery among patients who developed post-ERCP pancreatitis (PEP). While PEP does cause delays in surgical timing, these delays do not seem to translate into worse clinical outcomes for patients. Patients who develop PEP typically experience a temporary postponement of their planned surgical procedure until the acute pancreatitis resolves, which usually takes a few days with appropriate supportive care including bowel rest, intravenous fluids, pain management, and monitoring. This delay allows for resolution of the inflammatory process and stabilization of the patient's condition before undergoing surgery. The lack of significant differences in outcomes likely reflects the benefit of allowing adequate time for pancreatitis resolution before proceeding with surgery, as operating on a patient with active pancreatitis could potentially lead to worse outcomes. Additionally, modern perioperative care protocols and improved surgical techniques may help mitigate any potential negative effects of surgical delays in these patients. According to a meta-analysis of randomized controlled trials 1, aggressive hydration is associated with a significantly lower incidence of PEP, which may contribute to improved outcomes.
Some key points to consider in the management of PEP include:
- Aggressive hydration to reduce the risk of PEP 1
- Temporary postponement of surgical procedures until acute pancreatitis resolves
- Appropriate supportive care, including bowel rest, intravenous fluids, pain management, and monitoring
- Modern perioperative care protocols and improved surgical techniques to mitigate potential negative effects of surgical delays
It is essential to prioritize the patient's condition and stability before proceeding with surgery, as this approach may lead to better outcomes. The available evidence suggests that the delay in surgical timing due to PEP does not result in significant differences in perioperative outcomes, and the focus should be on providing optimal care and management of PEP to ensure the best possible outcomes for patients.