Background: Infectious complications are the main cause of late death in patients with acute pancreatitis. Routine prophylactic antibiotic use following a severe attack has been proposed but remains controversial. On the other hand, nutritional support has recently yielded promising clinical results. The aim of study was to compare enteral vs. parenteral feeding for prevention of infectious complications in patients with predicted severe acute pancreatitis. Methods: We screened 466 consecutive patients with acute pancreatitis. A total of 70 patients with objectively graded severe acute pancreatitis were randomly allocated to receive either total enteral nutrition (TEN) or total parenteral nutrition (TPN), within 72 h of onset of symptoms. Baseline characteristics were well matched in the two groups. Results: The incidence of pancreatic infectious complications (infected pancreatic necrosis, pancreatic abscess) was significantly lower in the enterally fed group (7 vs. 16, p = 0.02). In the TEN group, 7 patients developed multiple organ failure whereas 17 parenterally fed patients developed multiple organ failure (p = 0.02). Overall mortality was 20% with two deaths in the TEN group and twelve in the TPN group (p < 0.01). Conclusion: Early TEN could be used as prophylactic therapy for infected pancreatic necrosis since it significantly decreased the incidence of pancreatic infectious complications as well as the frequency of multiple organ failure and mortality.

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The early use of ERCP did not result in a significantly reduced risk of local pancreatic complications for either patients with mild acute pancreatitis or those with severe form of the disease.

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Controlling infection is crucial in treating patients with acute pancreatitis (AP). The infectious process in AP often predisposes to subsequent sepsis by damaging not only the pancreas, but retroperitoneal tissues as well. Among other AP-associated factors, are the rapidly developing immune imbalance, the poor penetration of antimicrobial agents into necrotic tissue, and the impossibility of a single surgical debridement. Antibacterial and antifungal therapy for patients with infected necrosis and AP-associated extra-pancreatic infections remains a complex and largely unresolved problem, partially due to the high occurrence of multiresistant pathogens. The preventive use of antimicrobial agents has been discussed in the literature; however, the lack of consistent results makes it difficult to develop a unified strategy and clinical guidelines on this specific issue. Recent meta-analyses provide no conclusive evidence that antibacterial prophylaxis reduces the infection rate, mortality, or the need for surgical treatment in patients with necrotizing pancreatitis. We found only two studies indicating the benefits of using carbapenems for prophylactic purposes and one meta-analysis indicating a reduction in mortality under antibiotic treatment started no later than 72 h after the onset of the attack. Selective bowel decontamination is considered as one of the preventive anti-infection measures, although the available data may not be fully reliable. The main indications for antibacterial therapy in patients with AP are confirmed infected necrosis or extra-pancreatic infection, as well as clinical symptoms of suspected infection. Intra-arterial administration or local treatment with antibiotics can increase the efficacy of antibacterial therapy. No randomized studies on antifungal prophylaxis in AP are available; some reports though recommend using such therapy among patients at high risk of invasive candidiasis.

Importance of the topic. Bleeding from ulcers of the gastroduodenal zone has been a very urgent problem in surgery for many years. According to a number of authors, the mortality rate is up to 30–40% with their relapse. Aim of the study is to create a prognostic scale for assessing the risk of relapse of ulcerative gastroduodenal bleeding. Materials and methods. The work is based on a retrospective analysis of 520 case histories of patients treated at the Berezov City Clinical Hospital No. 7, the basis of the Department of Faculty Surgery of the «Privolzhsky Research Medical University», regarding ulcerative gastroduodenal bleeding during 2010-2017. A comparative analysis of two groups of patients (depending on the occurrence or absence of relapse) is made in the SPSS-2.0 program using a logistic regression method in order to identify a combination of factors influencing the prognosis of the disease. Results and their discussion. Such factors like the patient's age, the size of the ulcer, the use of combined endoscopic hemostasis, the intensity of bleeding at the time of an emergency EGD, the localization of the ulcer defect have a significant impact on the risk of recurrence. Basing to obtained data, we have developed a scale for assessing the risk of recurrence of ulcerative gastroduodenal bleeding. Conclusion. The presented method allows to attribute a patient to one or another risk group and it helps to choose the optimal treatment tactics in a short period of time.

Aim: to evaluate the prospects of using systems with negative pressure in purulent-inflammatory complications of prosthetic abdominal wall repair.Materials and methods: 51 patients were observed with purulent - inflammatory complications of prosthetic repair performed for abdominal wall hernias. Group I included 32 patients who developed an acute para-prosthetic inflammatory process (abscesses, phlegmon, infarction of the abdominal wall with infection, suppuration of the wound) up to 30 days after the intervention, group II included 19 patients with signs of chronic infection associated with with a previously implanted mesh (purulent fistulas, chronic abscesses of the abdominal wall). All patients underwent revision and debridement of the purulent site, if necessary, necrectomy, for some individuals complete or partial excision of endoprostheses, some patients used negative pressure therapy (NPWT), others performed only standard procedures generally accepted for purulent infection.Results: It was found that in individuals with acute inflammatory process (group I), the use of NPWT made it possible in all cases to preserve the network in situ. The need for repeated operations using this technology in acute surgical infection was significantly less (p = 0.00063, Fisher). The strength of the link between the risk factor (refusal to use NPWT) and the outcome (repeated intervention) is relatively strong (C = 0.514, Pearson, V = 0.599, Cramer). In a chronic purulent process, a decrease in the need for repeated interventions was not significant (Fisher, p = 0.26213), and the strength of the relationship between the risk factor and outcome was average (Pearson, C = 0.325, Cramer, V = 0.344).Conclusion: using of NPWT in chronic mesh infection involves partial excision of the endoprosthesis, and the possibilities of the technique require further study.

The paper presents an analysis of the recent studies on the various aspects of surgical management of acute (excluding biliary) pancreatitis. It evaluates the suggestion of interventions in the sterile phase, which are limited to and include enzymatic peritonitis and abdominal compartment syndrome. Surgery is suggested when conservative treatment is ineffective, pain is present, which is associated with pancreatic fluid accumulation, there is a risk of the pancreatic fluid leaking into the abdominal cavity, or compression of the adjacent organs develops due to the disconnected pancre-atic duct syndrome. Infected necrosis is the main indication for surgical intervention in acute pancreatitis. The drainage is preferably delayed for at least 4 weeks following the onset of the disease, and is gradually performed (in a “step-up” manner). The choice of drainage technique is based on the necrosis localization, delimiting wall, surgeon’s expertise, and technical capabilities. Sequestrectomy can be performed starting from mini-invasive percutaneous drainage under endoscopic guidance, or using a covered metal stent. In the cases of early infection or advanced injury of retroperitoneal tissue, it is advisable to combine percutaneous and endoscopic methods, and use multiple transluminal gateway techniques with several draining tracts installed from single or multiple points of access.