Role of surgery in the management of acute pancreatitis.

Abstract

AbstractThree important aspects of the surgical therapy of acute pancreatitis are discussed: the time at which operation appears to be indicated, the procedure to be chosen (in accord with operative findings), and the results. After initial medical treatment, the timing of intervention should be based on clinical and biological information. Classification of acute pancreatitis in 3 degrees of severity may facilitate the decision. When edematous pancreatitis is found, irrigation and drainage are indicated. For distal necrosis, a left or subtotal pancreatectomy should be carried out. Necrotic lesions of the isthmus should be excised locally; if necessary, local isthmus excisions may be combined with left pancreatic resection. Resections of the head of the pancreas have been abandoned because of their high mortality rate; intervention is now limited to local excision of necrotic tissue (necrosectomy), with drainage and irrigation. In all cases, complementary biliary drainage by choledochostomy or at least cholecystostomy, drainage of areas of necrosis, and gastric suction are also mandatory. Forty‐nine patients who were operated upon according to these principles with a mortality rate of 36.7 % are discussed.