Acute pancreatitis. Surgical management.

In general, the best approach to pancreatitis is to recognize its presence early, resuscitate the patient aggressively, and employ nutritional and medical therapy to avoid complications. Nonetheless, either because of trauma or failure of medical therapy, some patients develop complications (e.g., hemorrhagic or necrotizing pancreatitis, abscess, pseudocyst, or fistula) that require operative intervention. Expert surgical judgment is required to decide which patients require surgery, when to operate, and what operation(s) to perform. Many of these patients require multiple surgical procedures and are critically ill, requiring careful attention to nutritional support, ventilatory management, and surveillance for sepsis. The care of these patients requires a multidisciplinary approach involving personnel in internal medicine, gastroenterology, radiology, surgery, anesthesiology, and nursing. Pancreatitis does not respect the boundaries of class, race, creed, gender, or traditional specialty interests; only by using a collegial approach, which shares expertise in a multidisciplinary fashion, is it possible to optimize patient care and salvage critically ill patients with this deadly disease.