Surgical indications in acute pancreatitis
Barbara Haas1, Avery B Nathens
1Department of Surgery, St Michael's Hospital, University of Toronto, Toronto, Canada. barbara.haas@utoronto.ca
Current Opinion in Critical Care
|January 16, 2010
Summary
Surgical management of acute pancreatitis, particularly infected pancreatic necrosis, is evolving. Minimally invasive debridement techniques show promise for critically ill patients, but evidence quality is limited.
Area of Science:
- Surgical Management
- Critical Care Medicine
- Gastroenterology
Background:
- Infected pancreatic necrosis is the main surgical indication in acute pancreatitis.
- Early bacteremia and pneumonia complicate up to 25% of acute pancreatitis cases.
- Thorough assessment for non-pancreatic infection sources is crucial before surgery.
Purpose of the Study:
- To provide an updated review on the surgical management of acute pancreatitis.
- To focus on recent evidence concerning pancreatic debridement in critically ill patients.
Main Methods:
- Review of evidence accumulated over the past year.
- Focus on surgical and minimally invasive debridement techniques.
- Analysis of patient selection for necrosectomy.
Main Results:
- Minimally invasive approaches (retroperitoneal, percutaneous, endoscopic) for pancreatic debridement are effective in selected critically ill patients.
- No single minimally invasive approach is currently superior due to insufficient evidence.
- Management at high-volume centers correlates with improved survival rates.
Conclusions:
- Non-laparotomy control of infected pancreatic necrosis is achievable with careful patient selection.
- The quality of evidence supporting minimally invasive debridement techniques requires improvement.
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