External application of mirabilite before surgery can reduce the inflammatory response and accelerate recovery in mild acute biliary pancreatitis

Abstract

Objective: Mild acute biliary pancreatitis (MABP) is one of the most common diseases that require surgical treatment. Previous studies have focused on the timing of laparoscopic cholecystectomy (LC) for MABP. However, the impact of its inflammatory response process on the clinical outcome has been rarely reported. This study aimed to investigate the effect of preoperative external application of mirabilite on the inflammatory response and clinical efficacy in MABP.

Methods: Medical records of patients undergoing LC due to MABP from November 2017 to June 2022 were retrospectively reviewed. Prior to surgery, the control group received the same baseline treatment measures as the study group. The difference was the addition of external application of mirabilite in the study group.

Results: A total of 75 patients were included in the final analysis: 38 patients in the mirabilite group and 37 patients in the control group. Repeated-measures ANOVA (P < 0.01) showed that the white blood cell count (WBC) on the 3rd day of admission and the WBC and C-reactive protein (CRP) level on the 5th day of admission decreased rapidly and significantly in the mirabilite group, compared with the control group. The mirabilite group had earlier anal exhaust time. The number of patients in the mirabilite group and control group with gallbladder wall ≥ 3 mm before the operation was 16 (42.11%) vs. 24 (64.86%), p = 0.048, respectively; and the number of cases with surgical drain placement was 2 (5.26%) vs. 9 (24.32%), p = 0.020, respectively. The intraoperative modified American Fertility Society (mAFS) score of adhesions was lower in the mirabilite group (1.08 ± 0.59 points) than in the control group (1.92 ± 0.60 points), p = 0.000. The mirabilite group, compared to the control group, p = 0.000, had a short waiting time for surgery (5.68 ± 0.70 days vs. 6.54 ± 0.59 days), short operation time (38.03 ± 5.90 min vs. 48.51 ± 8.37 min), and reduced hospitalization time (8.95 ± 0.96 days vs. 9.84 ± 1.07 days).

Conclusion: This study demonstrated that preoperative external application of mirabilite can reduce the inflammatory response, decrease the edema and peribiliary adhesions at the surgical site, and accelerate recovery in MABP.

Keywords: Adhesion; Biliary pancreatitis; Inflammatory response; Laparoscopic cholecystectomy; Mirabilite.

Fig. 1

The filtering process: From November 2017 to June 2022 patients with mild acute biliary pancreatitis (MABP) (n=221). Exclusion (n=137) : not the same-admission laparoscopic cholecystectomy(n=43); history of upper abdominal surgery or radiotherapy (n=19) ; repeated or chronic abdominal pain (n=43) ; common bile duct stone were found on admission (n=25) ; postoperative gallbladder pathological diagnosis of a chronic proliferative lesion or tumor (n=4) ; autoimmune diseases (n=3) . The mirabilite group and the control group both had 42 cases patients, respectively. The mirabilite group: exclusion (n=4) : unplanned discharge (n=2) ; use of mirabilite for less than 3 days (n=1) ; incomplete information (n=1) . The control group: exclusion (n=5) :unplanned discharge (n=4) ; common bile duct stones found before surgery (n=1)