Surgical Strategies in Severe Acute Pancreatitis (SAP): Indications Complications and Surgical Approaches

Background: Severe acute pancreatitis (SAP) is still related tohigh mortality rates. This study evaluated the various surgicalstrategies for treatment of suspected infected necrozitingpancreatitis (INP).Methods: This retrospective study included 212 patients withSAP and INP, who had surgical treatment during the periodbetween January 2000 - December 2012 at the Ist SurgicalClinic. Surgical approaches included laparostomy withcontinous postoperative retropancreatic lavage, open abdomenstrategy, laparotomy with primary abdominal closure accompaniedor not by laparostomy (marsupialization), retroperiostomywith retroperitoneal lavage.Results: The overall mortality rate was 34.0 percent, with 24percent in laparotomy with continous retropancreatic lavage,11 percent for retroperitoneostomy and retroperitonealcontinous lavage, 71 percent for the open abdomen strategy,and 43 percent for laparotomy with closed abdomen(p 0.001). Acute operations, alcoholic origin, Apache IIscores of ≥10 organ dysfunction on admission wereindependent factors that predisposed patients to complications.Colonic necrosis with high mortality rates (53 percent), however seemed to be of prognostic relevance.Conclusions: The conservative approach in severe acutepancreatitis is a promising therapeutic concept. Delayingsurgery up to the third week after onset of diseasesignificantly improves the patients’ survival. Complicationsare common in severe necrotizing pancreatitis leading toorgan failure and need for acute operations. Colonicnecrosis is an independent prognostic factor for survival.

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