An acute complicated pancreatitis: principles of surgical tactics, using miniinvasive technologies and standard operations

Abstract

Objective. To elaborate a surgical tactics for patients, suffering  an acute complicated pancreatitis (ACP), using miniinvasive technologies (МІТ) and standard surgical interventions. Маterials and methods. There were operated 170 patients, suffering ACP. In the main group (109 patients) a МІТ was applied, and in a comparative one (61 patients) the standard operations were used. Results. МІТ as the «definite» were applied in 62 (57%), «staged» - in 16 (15%) and «the patient’s state stabilizing» - in 12 (11%) patients. The part of operative interventions in the main group have constituted 26%, and in a comparative one - 12% (χ2=4.002; р=0.04). Primary laparotomic operations were performed in 41 (67%) patients of a comparative group and 19 (17%) patients of the main group (χ2=40.291; р<0.0001). Standard operations, mainly consisted of necrosequestrectomies (NSE) with the closed drainage in accordance to Berger procedure were performed in 26 (55%) patients of the main and in15 (31%) patients of comparative group (χ2=5.018; р=0.02). The NSE quantity with further staged sanations, which were conducted in patients, suffering extended purulent-necrotic affections, was comparable in both groups: 11 (23%) - in the main and 13 (26%) - in a comparative group (χ2=0.0013; р > 0.05). Conclusion. Application of elaborated tactics of surgical treatment of an ACP with a separate or combined application of МІТ and standard operations was accompanied by reduction of postoperative complications rate from 13.1 tо 8.3% and lethality - from 14.8 tо 9.2%.