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A Journal on Surgery
Indexed/Abstracted in: EMBASE, Scopus, Emerging Sources Citation Index
Chirurgia 2004 February;17(1):7-10
Management of severe acute pancreatitis. Our experience
Salamina G., Garbini A., Bertoncini M., Ceccarelli L., Di Pierdomenico M., Sarro G., Poccobelli M., Bragherio G.
Aim. The aim of this study was to define what is the best management and timing and type of surgery, if suitable, in severe acute pancreatitis.
Methods. A total of 34 consecutive patients affected by severe acute pancreatitis hospitalized from 1988 to 1995 have been studied: 29 (85.3%) had gallstone pancreatitis, 3 postoperative, 1 alcoholic, 1 pancreatitis in a benign neoplasm of the head of the pancreas. Fifteen (51.7%) out of 29 patients affected by gallstone pancreatitis underwent endoscopic retrograde cholangio-pancreatography (ERCP) and sphincterotomy (ES) and, thereafter, 12 of them were submitted to cholecystectomy. Twelve (41.4%) out of the remaining 14 patients underwent cholecystectomy with ES in a single stage. Six (17.6%) patients underwent laparotomic pancreatic debridement with lavage and drainage.
Results. Complications due to ERCP+ES alone were: 2 (11.1%) haemorrhages and 1 (5.5%) angiocholitis. Complications due to debridement were: 1 (16.7%) recurrence of severe acute pancreatitis; 1 (16.7%) case of ARDS. One (16.7%) patient died of postoperative acute myocardial infarct.
Conclusion. In severe acute gallstone pancreatitis ERCP+ES is always suitable if there is no improvement within 24-48 hours. Laparoscopic cholecystectomy is performed after resolution of the acute event but always during the same hospitalization. Surgery is mandatory in the presence of infected pancreatic necrosis. In order to reduce complications and mortality, the most important factor is the accuracy of the 1st operation.