Abstracto

Acute pancreatitis: surgery and interventional extensive care.

Jack Wilson

In recent years, the focus of therapy for severe acute pancreatitis has moved from immediate surgery to rigorous intensive care. While conservative therapy is recommended in the early stages of the disease, surgery may be considered in the later stages. The “gold standard” for treating infected pancreatic and peripancreatic necrosis is still surgical debridement. Over the last several decades, advances in radiological imaging, interventional radiology, and other limited access treatments have revolutionised the care of a variety of surgical diseases. Endoscopic Retrograde Cholangiopancreatography (ERCP) and sphincterotomy, Fine Needle Aspiration For Bacteriology (FNAB), percutaneous or endoscopic drainage of peripancreatic fluid collections, pseudocysts, and late abscesses are only a few of the interventional treatment options, as well as selective angiography and catheter-directed embolisation of acute pancreatitis-related bleeding problems, have long been accepted as diagnostic and therapeutic gold standards in the treatment of acute pancreatitis. Because of recent technological advances in interventional treatment and minimally invasive surgery, infected pancreatic necrosis has been effectively treated in a small number of individuals. Technical feasibility, on the other hand, does not exclude competent clinical judgement. In the absence of well-designed clinical studies, we must exercise caution when using new technology. Thus, minimally invasive surgery and interventional treatment for infected necrosis should be restricted to clinical trials and particular reasons in severely sick patients who are otherwise unfit for traditional surgery.