[Surgical indications and timing in severe acute pancreatitis]

Infected pancreatic necrosis is the major risk factor with regard to morbidity and mortality in severe acute pancreatitis. Whereas surgery for sterile necrosis can only be recommended in selected cases, infected pancreatic necrosis is a well-accepted indication for surgery. Surgery should be postponed until 4 weeks after the onset of symptoms, as necrosis is well demarcated at that time. Two surgical techniques can be performed with comparable results regarding mortality: necrosectomy combined with closed continuous local lavage or open drainage. Selection of these techniques depends on the extent of infected peripancreatic fat necrosis. Open drainage seems to be selected for the cases in which infected tissue is extensively found. However, local lavage is associated with the lower morbidity than open drainage.