Key aspects of modern surgical approaches in the treatment of acute necrotic pancreatitis

Abstract

Objective to set indications to minimally invasive interventions in patients with acute necrotizing pancreatitis considering pheses, complications and morphological features of disease. Materials and methods. The clinical data of 1572 patients with acute pancreatitis were analyzed. Diagnosis and treatment algorithm was used considering pathological stages of acute pancreatitis. New methods of minimally invasive necrozectomy, percutaneous drainage of fluid collections, methods of intraabdominal hypertension management were surgical proposed for acute infected necrotizing pancreatitis treatment. Results and discussion. Treatment tactics depended on the phase of acute pancreatitis. On the early stage using of different types of interventions was limited. The timing of minimally invasive drainage of fluid collections is strictly limited due to possible colonization of fluid and necrotic collections with microorganisms, and as a result infectious complications. Infected pancreatic necrosis requires drainage with increasing diameter of catheter. Percutaneous catheter drainage was successful as final treatment in 5,1 % cases in group of patients with acute infected necrotizing pancreatitis. In 64,7% of cases percutaneous catheter drainage was helpful in avoiding general infections complications, and on late stage surgical debridement was performed. Conclusions. Treatment of acute severe pancreatitis requires complex multidisciplinary approach, with attention to local and systemic complications.