[Pancreonecrosis and its complications, basic principles of surgical approach].

Results of treatment of 4970 patients with acute pancreatitis are presented. Acute destructive pancreatitis was seen in 572 (11.5%) cases. The disease severity was the basis of differential approach to treatment. Necessity of differential approach to choice of treatment policy is demonstrated. Mild and moderate acute destructive pancreatitis in the period of arising early postnecrotic aseptic complications requires combined conservative treatment, laparoscopic sanation and drainage of abdominal cavity and omental sac are indicated when peritoneal symptoms increase. Surgical treatment in patients hospitalized with mild and moderate acute destructive pancreatitis is indicated in early (on day 5-7 after the disease onset) and late (at least 2 weeks) postnecrotic septic complications requiring delayed and late miniinvasive and extended surgeries. Severe acute destructive pancreatitis in the period of developing early postnecrotic aseptic complications associated with severe endogenous intoxication, immunosuppression, polyorganic insufficiency is indication to early (the disease day 1-3) and delayed (day 5-7) surgeries, which are regarded as one of methods of surgical detoxication.