[Surgical treatment of acute destructive pancreatitis]

The possibilities of the accepted surgical tactics in the treatment of acute destructive pancreatitis based on a single operative intervention with drainage of the omental bursa and retroperitoneal space are very limited. It is not always possible to remove the necrotic tissues fully, arrest the inflammatory process, and completely cleanse the abdominal cavity, omental bursa, and parapancreatic fat during the operation. Reasoning from this, the authors suggest a method for treating acute destructive pancreatitis. It consists in the creation of an omentobursopancreatostoma followed by stage endoscopic necrectomy of pancreatic areas and endoscopic control over the course of regeneration in the omental bursa and retroperitoneal space till a chronic pancreatic fistula forms, which usually spontaneously closes later. With the use of this method in 46 patients with pancreonecrosis, postoperative complications and mortality reduced.