[Conservative surgical treatment of acute pancreatitis. Strategy and technic]

Not all patients with acute pancreatitis can be cured by medical treatment alone; surgery is mandatory when signs of aggravation or complications are present. The authors propose a new strategy involving bilateral subcostal laparotomy, wide approach to the pancreas, evaluation of the lesions and therapeutic decision: either abstention or excision which may be performed according to rules or adapted to each case. The abdominal wall is then closed, often around a pre- and peripancreatic Mikulicz's drain. This method has substantial advantages: the dangers of hasty and inappropriate surgical procedures on ill-defined lesions are avoided, necrotic areas can be removed, drainage is facilitated and possible reoperations are restricted to the supramesocolic cavity.