Features and tactic of surgical treatment of acute biliary pancreatitis

Abstract

Introduction. Acute biliary pancreatitis has for many years remained an urgent problem of surgery, and approaches to its treatment are prompted by lively discussion among both scientists and practitioners. The aim of the study. Perform an analysis of the surgical tactics of treating patients with acute biliary pancreatitis. Materials and methods. 94 patients with acute biliary pancreatitis were included in the study. Types and results of surgical treatment of patients, the course of the disease, depending on the type of the surgical procedure performed, were analyzed. Results and discussion. In our study, the main stages of treatment of patients with acute pancreatitis of biliary origin were: • Removal of concrements from the common bile duct by performing endoscopic papillosphincterotomy. • After removal of the main clinical symptoms in patients with mild disease, laparoscopic cholecystectomy was predominantly performed on the 6-7th day of stay in the hospital. • In the presence of destructive cholecystitis against the background of acute pancreatitis, active management tactics were used (laparoscopic cholecystectomy with intraoperative cholangiography and external biliary drainage). • In conditions of obstructive jaundice and detection of pathological processes in extrahepatic biliary tracts, the first stage of treatment was the endoscopic retrograde cholangiopancreatography in combination with endoscopic papillosphincterotomy. • In case of necrotic pancreatitis, emergency surgery was performed only for patients who had a clinical picture of peritonitis (laparoscopic sanitation and drainage of the abdominal cavity, laparoscopic cholecystectomy with mandatory external biliary drainage). • Open surgical intervention was performed in patients who had sepsis symptoms associated with infection of pancreatic necrosis (revision of the pancreas with necroctomy and subsequent postoperative continuous closed lavage of the retroperitoneal space). Conclusions. Surgical treatment of acute biliary pancreatitis should be carried out with individualized tactics based on a number of factors, such as the severity of acute pancreatitis, the presence of other complications of cholelithiasis, the effectiveness of primary conservative therapy.