Surgical treatment of acute pancreatitis today

Abstract

sterile pancreas necrosis is rarely but septic necrosis is an indication for surgery if the conservative treatment is unsuccessful. Therapy resistant multiple organ failure, abdominal compartment syndrome and other surgical complications such as bleeding, perforation need surgery treatment. In biliary pancreatitis associated with cholestasis urgent endoscopic sphincterotomy and later cholecystectomy is suggested. In case of pancreas necrosis the ideal time of operation is 21 days after the beginning of the disease because the rate of complications and mortality is high in early operations. Careful necrosectomy is important which has to be extended to the retrocolic and retroduodenal areas as well. Open abdominal surgery has more complications so it is suggested only in selected cases. Operation should be amended with postoperative bursa omental lavage.

Effect of Early Continuous Veno-Venous Haemofiltration in Severe Acute Pancreatitis for the Prevention of Local Pancreatic Complications

“…After the advance understanding of the path physiology of SAP, the treatment mode has changed over the past few years. The early and aggressive management of SAP has been used extensively, such as TNF-alpha monoclonal antibodies, IL receptor antagonist, PAF antagonist [ 30 ], persistence of surgery [ 31 ], peritoneal lavage [ 32 ], dialysis [ 19 ], continuous arterial infusion of protease inhibitor [ 33 , 34 ], and endothelin receptor antagonist to reduce capillary leakage [ 35 ], in addition to intensive care. During SAP, both pro- and anti-inflammatory mediators become unregulated and interact with each other, leading to cascades of chain reactions, so neither antagonist treatment directed at one mediator nor the single dose intervention was effective.…”