Treatment in severe acute pancreatitis--still a reason of debate

Surgical therapy in severe acute pancreatitis significantly evolved in the last 10 to 20 years. The aim was to present the experience of the First Surgery Clinic within the University Emergency Hospital Bucharest, in the management of severe acute pancreatitis, following major etiopathogenic, diagnostic and treatment aspects. Our study was retrospective, longitudinal and descriptive, including a seven years period, between 2004 and 2010. 42 patients diagnosed with severe acute pancreatitis have been admitted and operated. 25 were male, representing 59,52% and 17 female, respectively 40,47%. 55% of the patients were operated more than 11 days after the hospitalization, 25% were operated in the 4 to 10 days interval and 20% were operated in emergency conditions: immediate emergency (first 24 hours) or delayed emergency (24-72 hours). Mortality reported to the moment of surgery was 60% for the patients operated in the first 24 hours, 66,67% for the 24-72 hours operation interval, 30% for the patients operated between 4-10 days from the admission and 18,18% for operations performed after more than 11 days .

mortality significantly decreased when the surgical moment was postponed by using intensive therapy, over 11 days from admission. We reconfirm the optimal temporization attitude of surgery, until the infection of necrosis or appearance of pancreatic abscess.