[The timing and mode of surgery in patients with severe acute pancreatitis]

To investigate the timing and mode of surgical management in patients with severe acute pancreatitis (SAP).

The timing, mode of operation and mortality were reviewed retrospectively in 50 SAP cases undergoing laparotomy in our hospital from 1985 to 1994.

The overall mortality was 14% and 85.7% of the mortality falls on the age between 40 to 60 years, with no difference in etiology and sex. The operative mortality reduced gradually in patients with longer duration of illness (P > 0.05). The operative mortality of 31.8% in patients undergoing laparotomy within 12 h after hospitalization was significantly higher (P < 0.05) than in these operated on later. When the number of injured extra-pancreatic organs increased, the mortality also increased significantly (chi(2) = 5.99, P < 0.05). The related mortality with shock, pancreatic necrosis and multiorgan failure (MOF) was 31.8%, 31.6% and 28%, respectively (P < 0.05). The main procedures of surgical management were pancreatic debridement and/or drainage, and combined surgical measures.

The laparotomy timing is an important factor influencing mortality as well as the severity of pancreatic necrosis, sepsis, and MOF. Delayed laparotomy and 24 h preoperative management is recommended. Surgery adopted should be simple, efficient in drainage and debridement.