[Acute pancreatitis--conservative versus surgical therapy].

Based on own studies and on results of other centers the multiorgan failure (MOF) resp. the systemic inflammatory response syndrome (SIRS) in acute necrotizing pancreatitis seems to be no longer an compelling reason for surgery in the absence of proven infection of pancreatic necrosis. Growing experience of continuous veno-venous hemofiltration (CVVH) facilitates successful conservative treatment of-formerly often lethal-cases of serious necrotizing pancreatitis. If infection of necrosis is documented surgical intervention should be performed. Our present regime of therapy of necrotizing pancreatitis consists in conservative intensive medical treatment, immediately after admission; a pancreas penetrating antibiotic medication starting on admission; early use of continuous veno-venous hemofiltration if MOF or SIRS occurs, surgical intervention, if infection of necrosis is proved. Other indications for surgery are massive bleeding or bowel perforation due to tryptic lesions.