[OPEN NECROSECTOMY IN THE COMPLEX TREATMENT OF THE SEVERE ACUTE PANCREATITIS]

The aim of the study was to determine the indication for the method of open abdomen-open necroseqtomy in the complex treatment of acute pancreatitis. 74 patients with the diagnosis of acute pancreatitis were selected for the treatment. Patients were divided by severity of disease: mild acute pancreatitis - 29 patients were treated by conservative method; moderate acute pancreatitis - 29 patients were treated by following methods: 17 patients - by conservative method; 4 patients by conservative treatment with fasciotomy; 8 patients - by open abdomen method without fasciotomy after conservative treatment. Severe acute pancreatitis - 16 patients were treated by following methods: 2 patients by open abdomen technique with single necroseqtomy and sanitation after fasciotomy, 8 patients - with the method of open abdomen from which 3 patients needed a single necroseqtomy and sanitation, 3 patients had a double necroseqtomy and sanitation and 2 patients three and four times the necreseqtomy and sanitation were used with a fastener, 6 patient were treated conservatively. We identified indication and contraindication for treatment of severe acute pancreatic necrosis by open necroseqtomy. Indications: 1) Pancreatic and/or peripancreatic necrosis (based on contrast-enhanced dynamic CT scan) complicated by documented infection (guided FNA culture or extraluminal retroperitoneal gas). 2) Sterile necrosis with progressive clinical deterioration despite maximal medical treatment. Contraindications: 1) Pancreatic and/or peripancreatic necrosis without evidence of infection or clinical deterioration. 2) Early operation (within a week from onset of acute pancreatitis) before the systemic inflammatory response syndrome (SIRS) is stopped and intensive conservative treatment is still required.