[Surgical treatment of acute pancreatitis]

In the initial stage the treatment of acute pancreatitis must be medical. If there is not positive improvement after 2 to 6 days or in cases of associated cholelithiasis, surgery is indicated. The first step in surgery is a search for necrosis and hematomas, and their exact topographic localization. These findings will determine the final tactics, which may be drainage only, partial or exceptionally, total resection, or necrosectomy (which is not to be confused with a sequestrectomy !). Indications for these different types of operation are outlined and discussed. They are supplemented by large-scale drainage/lavage of the abdomen, choledocostomy or at least cholecystostomy, and temporary exclusion of the upper portion of the digestive tract. 30 personal cases treated according these principles are discussed.