[The development of surgical therapeutic concepts of acute severe pancreatitis]

The actual surgical concepts concerning the treatment of acute pancreatitis are described. Owing to sonography and above all to computed tomography, constantly compared with clinical data, the surgical decisions can be more easily conducted. In acute pancreatitis of biliary origin, endoscopic sphincterotomy is mandatory in a great number of cases, followed by complete de-obstruction of the common bile duct. That procedure has the advantage of reducing notably mortality and morbidity. In idiopathic pancreatitis, 4 therapeutic behaviours which correspond to 4 different clinical types, are to be faced: --or after 5 to 6 days, division of the left hypochondrium with performing of a meticulous cleaning, followed by a large drainage lavage, --if all reanimation measures have failed, earlier surgery, often of the last chance, consisting in necrosectomy as extended as necessary, --in right away appearing pancreatic phlegmon, a very large drainage, --or, a more expecting attitude in cases in which resorption of the necrotic spots appears to be very slow on CT-Scan, but without any clinical abnormality. Figures support these concepts and prove their warranty.