Surgical Treatment of Acute Pancreatitis

Abstract

Acute pancreatitis is a common disease ranging in severity from a mild form to multiple organ failure and sepsis. Approximately half of death due to severe acute pancreatitis occur within 14 days and most are due to multiple organ failure. The late deaths are mostly due to infected necrosis. Treatment of severe acute pancreatitis has shifted from early surgical intervention to aggressive intensive care in recent years. The principle of therapy is mostly conservative in the early phase, and surgery is usually considered in the later phase of disease. Surgical debridement is indicated for removal of infected pancreatic and peri-pancreatic necrosis. With advances in radiological imaging, interventional radiology, and other minimal surgical access procedures, the management of many surgical conditions has changed. Several interventional techniques, including endoscopic retrograde cholangiopancreatography and endoscopic papillotomy , fine needle aspiration for bacteriology, percutaneous or endoscopic drainage of peri-pancreatic fluid collections, pseudocysts, and abscesses, as well as selective transarterial catheter embolization for associated active bleeding have been well established as diagnostic and therapeutic standards in the management of acute pancreatitis. With technical improvements in interventional therapy and minimally invasive surgery, even infected pancreatic necrosis has successfully been treated in selected patients. The minimally invasive endoscopic surgery and interventional therapy for infected necrosis should be limited to specific indications in patients who are critically ill and unsuitable for surgical laparotomy. The conclusion is that severe acute pancreatitis remains a serious medical problem, and the effective control of early multiple organ failure and treatment of systemic complications associated with infected necrosis require innovative strategies.