Position of surgical treatment in step-up management of severe acute pancreatitis

Česká verzia

Authors: J. Sedláčková ¹; J. Zajak ¹ ; B. Jon ¹; J. Maňák ²; S. Rejchrt ³; F. Čečka ¹
Authors place of work: Chirurgická klinika Fakultní nemocnice Hradec Králové a Lékařská fakulta Univerzity Karlovy v Hradci Králové ¹; III. Interní gerontometabolická klinika Fakultní nemocnice Hradec Králové a Lékařská fakulta Univerzity Karlovy v Hradci Králové ²; II. interní gastroenterologická klinika Fakultní nemocnice Hradec Králové a Lékařská fakulta Univerzity Karlovy v Hradci Králové ³
Published in the journal: Rozhl. Chir., 2023, roč. 102, č. 2, s. 64-74.
Category: Original articles
doi: https://doi.org/10.33699/PIS.2023.102.2.64–74

Summary

Introduction: The incidence of acute pancreatitis has been increasing over the past twenty years and there is still no causal treatment available. Although cases of severe acute pancreatitis account for only about a fifth of all cases of acute pancreatitis, high morbidity and lethality call for an optimization and unification of treatment procedures.

Methods: We operated on 27 patients suffering from severe acute pancreatitis in the past five years. We compared selected parameters such as gender, age, body mass index, aetiology, presence of type 2 diabetes, BISAP score, previous minimally invasive treatment and presence of the intraabdominal compartment syndrome.

Results: The average age of men and women was similar in our group. Most patients were overweight or obese. Alcoholic aetiology was more common in men while biliary aetiology prevailed in women. The mortality rate was 26% in our group. The intra-abdominal compartment syndrome followed by emergency decompression surgery was present in one fourth of the patients. A minimally invasive approach was used in approximately in one half of the patients, and surgical treatment was used only in cases where the minimally invasive approach failed.

Conclusion: After each surgical revision, clinical deterioration of the patient´s condition occurs during the first two to three days in response to operative stress. Therefore, the current trend in the treatment of acute pancreatitis is to proceed as conservatively as possible, or using the minimally invasive approach, and surgical treatment should be reserved only for conditions that cannot be managed otherwise. If surgical treatment is used, it is advisable to perform cholecystectomy, whatever the aetiology of the pancreatitis.

Keywords:

surgical treatment – acute necrotizing pancreatitis – minimally invasive treatment – step-up approach – intra-abdominal compartment syndrome

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