SURGICAL-TREATMENT OF ACUTE-PANCREATITIS

The most important diagnostic step in the management of patients with severe acute pancreatitis is discrimination between interstitial-oedem atous and necrotizing pancreatitis. Surgical decision-making is based on clinical, bacteriological and contrast-enhanced CT-data. Persisting or progressive systemic or local organ complications occuring despite ICU-treatment are indicators for surgical management. Patients suffer ing from sepsis syndrome, cardiovascular shock, multisystemic organ fa ilure syndrome, surgical acute abdomen and persisting or progressing i leus should be treated surgically. The surgical technique is based on careful necrosectomy or debridement in combination with continuous or repeated surgical evacuation of necrotic tissue, bacteria and biologic ally active compounds. Necrosectomy and postoperative continuous local lavage resulted in a hospital mortality of 17 % in necrotizing pancre atitis, conservative management of necrotizing pancreatitis in a hospi tal mortality of 6.3 %. In 1442 patients treated in a 14-year period t he overall hospital mortality was 4.4 %.