[Surgical treatment of acute pancreatitis]

The aim of surgical treatment in acute pancreatitis is two-fold: 1. pancreatic necrosis excision; 2. suppression of possible cause. Pancreatic surgery is only indicated in acute necrotic pancreatitis with local or systemic complications. Necrosis excision with abdominal drainage has to be confined to patients with refractory systemic disorders despite intensive care management and in case of infected necrosis proved by positive culture of collection obtained under ultrasound or CT-scan. Necrosis excision can sometimes require iteratives laparotomies. Nevertheless, a 25%-hospital mortality rate remains observed in such cases. Surgery is often necessary in cases of pancreatic abcesses and pseudocysts because of the high failure rate of percutaneous treatment. Sometimes, surgery is also required in cases of haemorrhage, intestinal stenosis or perforation, due to the progression of peripancreatic necrosis. Treatment of biliary pancreatitis includes suppression of the biliary cause by cholecystectomy and common bile duct clearance in some cases. The indication of endoscopic sphincterotomy remains to be established.