[Surgical treatment of acute pancreatitis today].

UNLABELLED

In case of mild acute pancreatitis the treatment is basically conservative, but in severe cases surgical treatment has an important role.

METHODS

authors analyze the indications for operation, the timing and the technical questions of it on the basis of the literature published in the previous ten years.

RESULTS AND CONCLUSIONS

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.