SURGICAL-TREATMENT OF SEVERE ACUTE-PANCRE ATITIS - RESULTS OF A PROSPECTIVE MULTICENTRIC STUDY FROM THE FRENCH-ASSOCIATIONS-FOR-SURGICAL-RESEARCH

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 bi liary pancreatitis. Methods. - Forty-six centers participated in the s tudy. For every included patient, cause and severity criteria of the p ancreatitis, timing of surgery, surgical management and necrosis featu res were recorded. Mortality and morbidity, number of surgical operati ons and clinical course were analyzed depending an necrosis infection. Results. - From August 1986 to January 1990, 143 patients were includ ed in the present study. The main causes of pancreatitis were gallston es in 66 patients and alcohol in 45. Other causes were found in 32 pat ients. Overall mortality was 23.8 %. Mortality was higher in 38 patien ts with infected necrosis than in 41 patients with sterile necrosis (3 9 % vs 27 %). In patients with severe acute biliary pancreatitis opera ted on within the first seven days of pancreatitis, mortality and numb er 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.