Surgical Treatment of Patients with Acute Pancreatitis in Sterile Stage and in Biliary Etiology of the Disease

Abstract

The main indication for surgical treatment in acute pancreatitis (AP) is infected necrosis in the late phase of the disease. However, some patients require surgery in the sterile stage including the earliest period. In sterile necrosis interventions are associated with the risk of infection and increased mortality, being the responsibility of a surgeon. Patients with biliary AP often require early interventions and specific tactic regarding the pathology of the biliary tract. The review analyses recent studies and modern practical recommendations on the surgical treatment of patients with AP in the sterile stage and in biliary etiology. Obstruction of bile duct and cholangitis, enzymatic peritonitis, abdominal compartment syndrome caused by ineffective conservative measures, massive pancreatogenic accumulations with the threat of a rupture into the abdominal cavity, pain syndrome, compression of the adjacent organs often resulted from the disconnected pancreatic duct syndrome require invasive interventions to prevent the development of infectious necrosis. A number of questions have an ambiguous solution. The threshold level of intra-abdominal pressure, the rate of its increase, or other apparent criteria for the implementation of surgical decompression and the choice of decompression technique for abdominal compartment syndrome have not been stated. The optimal timing and the priority method of drainage in the disconnected pancreatic duct syndrome remain uncertain. The management of patients with biliary acute pancreatitis regarding prophylactic endoscopic papillotomy is controversial. Further, well-designed research studies involving surgical treatment of patients with acute pancreatitis are needed.