[How long to wait with operations for necrotizing pancreatitis?]

Severe acute pancreatitis (pancreatitis with local and systemic complications) remains a therapeutical problem. Even more complicated is ESAP (Early Severe Acute Pancreatitis), which presents itself as a fulminant form (FAP--fulminant acute pancreatitis) and subfulminant form (SFAP--subfulminant acute pancreatitis). Severity of acute pancreatitis can be assessed with help of prognostic markers. Intensive conservative treatment as a part of "pancreatic unit" dominates the therapy. Couple things remain frequently discussed. First, indications for operative treatment, of which infectious complications of the necrosis and local intraabdominal complications are generally accepted. Second, optimal time of surgical intervention remains an issue discussed. Based on recommendations, patients should not be operated on in first two weeks of disease.

Aim of the authors was to evaluate their own group of patients in terms of indication and timing of the surgical intervention.

Authors analyse group of patients with acute pancreatitis, hospitalised on IVth surgical clinic of Comenius University, Bratislava in years 2006-2007. There were 125 patients in this group, 47 of these were classified as SAP (severe acute pancreatitis).

13 patients were operated on, 12 for retroperitoneal abscessus, ACS (abdominal compartment syndrome) and septic state, one patient for FAP. Patients were operated on between 17th and 80th day with average 28.8 days after onset. Overall mortality was 9.6%, mortality for SAP 21.2% and 15.4% in operated patients.

Authors conclude, that correctly timed surgical intervention does not aggravate mortality of patients with SAP, and ambition is to shift operation to time of necrosis and infection demarcation. Early indication in setting of failure of conservative treatment of ESAP remains discussed.