[Surgical treatment of severe acute pancreatitis. Results of a prospective multicenter study of the Associations of Research in Surgery].

OBJECTIVES

The aim of this prospective study was to appreciate, in severe acute pancreatitis, the therapeutic choice of the surgeons for the treatment of pancreatic necrosis and the timing of operation in biliary pancreatitis.

METHODS

Forty-six centers participated in the study. For every included patient, cause and severity criteria of the pancreatitis, timing of surgery, surgical management and necrosis features were recorded. Mortality and morbidity, number of surgical operations and clinical course were analyzed depending on necrosis infection.

RESULTS

From August 1986 to January 1990, 143 patients were included in the present study. The main causes of pancreatitis were gallstones in 66 patients and alcohol in 45. Other causes were found in 32 patients. Overall mortality was 23.8%. Mortality was higher in 38 patients with infected necrosis than in 41 patients with sterile necrosis (39% vs 27%). In patients with severe acute biliary pancreatitis operated on within the first seven days of pancreatitis, mortality and number of reoperations were higher than in patients operated on later (30% vs 14% and 40% vs 21% respectively).

CONCLUSIONS

These results suggest that clinical trials on the treatment of pancreatic necrosis and on the timing of the treatment of biliary pancreatitis are needed. The analysis of mortality shows that it will be difficult to organize these trials.