MINIMALLY INVASIVE AND TRADITIONAL OPERATIVE TECHNIQUES IN SURGICAL TREATMENT OF ACUTE COMPLICATED PANCREATITIS

Abstract

Introduction: The issue of surgical treatment of acute pancreatitis, in particular the choice of operative technique, is becoming increasingly relevant. The aim: To work out surgical approach in patients with acute complicated pancreatitis (ACP) using minimally invasive and traditional operative techniques. Materials and methods: 170 patients underwent surgery for ACP. The main group (109 subjects) had minimally invasive techniques (MIT) dominated, the comparative group (61 subjects) - traditional operations. Results: MIT performed "as final" in 62 (69%), "stage"- in 16 (18%) and "stabilizing patient condition" - in 12 (13%) of observations. The number of combined interventions predominated in the main group - 26% and 12% (χ2=4.002; р=0.04), traditional in comparative groups - 67% and 17% cases (χ2=40.291; р<0.0001). Primary laparotomy operations were used in 41 (67%) patients from comparative and 19 (17%) patients from the main group (χ2=40.291; р<0.0001). The extent of traditional operations in the maingroup consisted predominantly of necrosequestrectomy with Beger closed drainage - in 26 (55%) and 15 (31%) observations, respectively (χ2=5.018; р=0.02). Necrosequestrectomy with subsequent stage lavage performed in common purulent-necrotic lesions were comparable in both groups - in 11 (23%) and 13 (26%) observations (χ2=0.0013; р>0.05). Conclusions: The worked out surgical treatment approach in ACP with individual and combined use of MIT and traditional operations resulted in decreased rates of postoperative complications from 13.1% to 8.3% and mortality from 14.8% to 9.2%.