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[Indications for surgical therapy and operative technique in acute pancreatitis]
B Gloor1, M N Wente, C A Müller
1Klinik für Viszerale und Transplantationschirurgie, Universität Bern, Inselspital, Schweiz. beat.gloor@insel.ch
Abstract:
Eighty to eighty-five percent of all episodes of acute pancreatitis are mild and self-limiting, subsiding within a few days. In the remaining 15 to 20% of cases, however, severe necrotizing disease complicated by multiple organ dysfunction syndrome (MODS) develops. Early stratification according to disease severity is a cornerstone in the management of patients with acute pancreatitis. Patients suffering from mild disease do not need to be operated upon unless specific conditions such as bile duct stones, a tumour at the papilla of Vater or in the head of the pancreas are present. Patients suffering from severe disease are best managed by early intensive care treatment, including antibiotics penetrating into the pancreas in order to prevent infection of the necrotic tissue. Despite such a treatment infection occurs in up to one third of necrotizing cases, asking for surgical treatment. The latter consists of an organ preserving procedure, combined with a continuous postoperative lavage of the retroperitoneum. In 75% of our patients treated operatively, one surgical intervention was sufficient. Overall mortality in patients with necrotizing pancreatitis ranges, according to the current literature, between 6 and 50% and reaches 8% in our own series.
Insights
Most acute pancreatitis cases are mild. Severe cases require intensive care and potentially surgery to manage necrotizing pancreatitis and prevent multiple organ dysfunction syndrome (MODS).
Area of Science:
- Gastroenterology
- Surgical Gastroenterology
Context:
- Acute pancreatitis affects a significant number of patients, with a dichotomy in severity.
- Mild cases are self-limiting, but 15-20% progress to severe necrotizing pancreatitis.
- Severe cases can lead to multiple organ dysfunction syndrome (MODS).
Purpose:
- To outline the management strategies for acute pancreatitis based on disease severity.
- To emphasize the importance of early stratification for effective patient care.
- To detail treatment protocols for both mild and severe forms of the disease.
Summary:
- Eighty-five percent of acute pancreatitis cases are mild. Severe necrotizing pancreatitis necessitates early intensive care, including antibiotics, to prevent infection.
- Surgical intervention may be required for infected necrosis, often involving organ-preserving procedures and retroperitoneal lavage.
- The study highlights the effectiveness of a tailored approach, with a reported mortality of 8% in their severe necrotizing pancreatitis series.
Impact:
- Establishes early stratification as crucial for managing acute pancreatitis.
- Provides a framework for treatment decisions, differentiating between conservative and surgical management.
- Demonstrates improved outcomes in severe necrotizing pancreatitis with timely and appropriate interventions.