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A Journal on Surgery

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Minerva Chirurgica 2000 April;55(4):221-6

language: Italian

Severe acute pancreatitis. Clinical, diagnostic and therapeutic analysis

Testi W., Lorenzi M., Poggialini M., De Martino A., Coratti A., Spagnulo M., Tani F., Mancini S.


Background. The aim of this study is to define the actual role of surgical therapy in severe acute necrotizing panreatitis.
Methods. A retrospective analysis has been carried out on the surgical treatment of severe acute pancreatitis as the Institute of General Surgery and Surgical Specialities, University of Siena (Italy). From January 1980 to December 1997, 230 patients affected by acute pancreatitis were admitted to institution: 24 patients affected by severe disease (necrotizing pancreatitis: clinical and radiological diagnosis, by CT-scan) was choosen for this study. Of 24 patients, 15 were males and 9 females, with mean age of 55 years (range 30-80). In all cases, surgical procedure consisted in pancreatic necrosectomy, multiple abdominal and retroperitoneal drainage and closed management; operated patients with biliary pancreatitis underwent colecystectomy and, if necessary, common biliary duct drainage.
Results. Ten patients underwent surgical procedure, but the remaining 14 were treated by intensive medical care: mortality in these two groups was respectively 40% (4 cases) and 21% (3 cases).
Conclusion. The conclusion is draw that intensive medical care is the first therapeutic approach in severe acute pancreatitis, reserving surgery only to selected cases, as those affected by pancreatic infectes necrosis or those who get worse despite of conservative therapy. As to surgical technique, closed procedures vs open or semiopen, and conservative surgery (necrosectomy, multiple drainage and abdominal washing) vs anatomical resection are preferred.

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