An acute pancreatitis: what is new in surgical tactics after the Atlanta–2012 consensus?

Abstract

Objective. To delineate new approaches to surgical treatment in patients with an acute pancreatitis as development of principles of the Atlanta–2012 consensus and guidelines of the World Society for Urgent Surgery.
 Materials and methods. The results of treatment of patients in The Lviv Municipal Pancreatologic Centre were analyzed, using general clinical, the laboratory, biochemical, radiological, pathomorphological, bacteriological, pH–metric, cytomorphological and mathematic–statistical methods.
 Results. There was established, that local complications of an acute pancreatitis occur as solitary or multiple or coexistent foci of pathological processes. Diagnostic algorithm, taking into account the most informative indices (in accordance to criteria “sensitivity”, “specificity” and “diagnostic efficacy”), was proposed. Own predictors of severity of the disease – visual, pH–metric, cytomorphological and bacteriological – were elaborated. Taking into account the significance of early enteral feeding, the procedures of its transintestinal probe realization was proposed and their efficacy proved. The methods of analgesia without preparations–opiates and minimization of invasive way of the medicines administration were elaborated. Surgical tactics, using application of miniinvasive and standard operative technologies, was depicted.
 Conclusion. The renewed approaches to diagnosis and treatment of an acute pancreatitis are based on advances and gains of international and Ukrainian surgical pancreatology.