[Therapy of acute pancreatitis]

From 1973 to 1990 190 consecutive patients were admitted to the department of surgery of the Stadtspital Waid, Zurich, with a diagnosis of acute pancreatitis. 53 patients received conservative treatment, 93 patients with acute pancreatitis thought to be due to gallstones underwent cholecystectomy, in 23 cases combined with choledochotomy. 44 patient underwent pancreatic surgery. 10 diagnostic laparotomies, 14 necrosectomies, 6 pancreatic left resections and one subtotal pancreatectomy were performed. 9 pseudocysts and 4 pancreatic abscesses had to be drained. Over all mortality for operated patients was 29.5%, exceeding 50% for patients with operation within the first week of the disease. During the first ten years of our study we performed operations earlier and more often than in the following years (26 versus 17%). This more conservative management resulted in a marked reduction of mortality and complications. Today we try to control the first 8 to 10 days of the attack by intensive care and postpone pancreatic operations whenever possible to the second week.