Online first
Review article
Published online: 2025-03-11
Surgical treatment for acute pancreatitis and pancreatic necrosis
DOI: 10.5603/fm.102684
Pubmed: 40116439
Abstract
Pancreatitis, considered by clinicians as one of the most demanding abdominal disorders, is a life-threatening disease resulting in numerous complications if treated without early diagnosis or specialized medical care. Management is based on supportive care, including rehydration, pain control, continuous monitoring of vital signs and assessment of organ function, and on early oral feeding. However, there are cases such as acute gallstone pancreatitis, necrotising pancreatitis or acute fulminant (hemorrhagic) pancreatitis that require operative or surgical intervention. As the recent years have brought more experience in the treatment of different types and subtypes of pancreatitis, the guidelines concerning the most effective therapeutic methods, including invasive treatment, are now changing.
The aim of the research is to present surgical treatment of acute pancreatitis (AP) in the light of changing patterns of management.
Keywords: pancreatic necrosisacute pancreatitissurgical treatment
References
- Alsaad AA, Dhannoon SM, Phillips MB. Disconnected pancreatic duct syndrome: a multidisciplinary management dilemma. BMJ Case Rep. 2016; 2016.
- Arsenijevic T, Perret J, Van Laethem JL, et al. Aquaporins involvement in pancreas physiology and in pancreatic diseases. Int J Mol Sci. 2019; 20(20).
- Banks PA, Bollen TL, Dervenis C, et al. Acute Pancreatitis Classification Working Group. Classification of acute pancreatitis — 2012: revision of the Atlanta classification and definitions by international consensus. Gut. 2013; 62(1): 102–111.
- Banks PA, Gerzof SG, Langevin RE, et al. CT-guided aspiration of suspected pancreatic infection: bacteriology and clinical outcome. Int J Pancreatol. 1995; 18(3): 265–270.
- Carter CR, McKay CJ, Imrie CW. Percutaneous necrosectomy and sinus tract endoscopy in the management of infected pancreatic necrosis: an initial experience. Ann Surg. 2000; 232(2): 175–180.
- Cordemans C, De Laet I, Van Regenmortel N, et al. Fluid management in critically ill patients: the role of extravascular lung water, abdominal hypertension, capillary leak, and fluid balance. Ann Intensive Care. 2012; 2(Suppl. 1): S1.
- Dervenis C, Johnson CD, Bassi C, et al. Diagnosis, objective assessment of severity, and management of acute pancreatitis. Santorini consensus conference. Int J Pancreatol. 1999; 25(3): 195–210.
- Dimitriou I, Katsourakis A, Nikolaidou E, et al. The main anatomical variations of the pancreatic duct system: review of the literature and its importance in surgical practice. J Clin Med Res. 2018; 10(5): 370–375.
- Dolenšek J, Rupnik MS, Stožer A. Structural similarities and differences between the human and the mouse pancreas. Islets. 2015; 7(1): e1024405.
- Fan ST, Lai EC, Mok FP, et al. Early treatment of acute biliary pancreatitis by endoscopic papillotomy. N Engl J Med. 1993; 328(4): 228–232.
- Freeny PC, Hauptmann E, Althaus SJ, et al. Percutaneous CT-guided catheter drainage of infected acute necrotizing pancreatitis: techniques and results. AJR Am J Roentgenol. 1998; 170(4): 969–975.
- Gao YJ, Li YQ, Wang Q, et al. Analysis of the clinical features of recurrent acute pancreatitis in China. J Gastroenterol. 2006; 41(7): 681–685.
- Gerzof SG, Banks PA, Robbins AH, et al. Early diagnosis of pancreatic infection by computed tomography-guided aspiration. Gastroenterology. 1987; 93(6): 1315–1320.
- Working Group IAP/APA Acute Pancreatitis Guidelines. IAP/APA evidence-based guidelines for the management of acute pancreatitis. Pancreatology. 2013; 13(4 Suppl 2): e1–15.
- Johnson CD. Timing of intervention in acute pancreatitis. Postgrad Med J. 1993; 69(813): 509–515.
- Working Party of the British Society of Gastroenterology, Association of Surgeons of Great Britain and Ireland, Pancreatic Society of Great Britain and Ireland, Association of Upper GI Surgeons of Great Britain and Ireland. UK guidelines for the management of acute pancreatitis. Gut. 2005; 54 Suppl 3(Suppl 3): iii1–iii9.
- Kivilaakso E, Lempinen M, Mäkeläinen A, et al. Pancreatic resection versus peritoneal lavation for acute fulminant pancreatitis. A randomized prospective study. Ann Surg. 1984; 199(4): 426–431.
- Leppäniemi A, Tolonen M, Tarasconi A, et al. 2019 WSES guidelines for the management of severe acute pancreatitis. World J Emerg Surg. 2019; 14: 27.
- Machicado JD, Yadav D. Epidemiology of recurrent acute and chronic pancreatitis: similarities and differences. Dig Dis Sci. 2017; 62(7): 1683–1691.
- Mithöfer K, Mueller PR, Warshaw AL. Interventional and surgical treatment of pancreatic abscess. World J Surg. 1997; 21(2): 162–168.
- Mowery NT, Bruns BR, MacNew HG, et al. Surgical management of pancreatic necrosis: A practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg. 2017; 83(2): 316–327.
- Neoptolemos JP, Carr-Locke DL, London NJ, et al. Controlled trial of urgent endoscopic retrograde cholangiopancreatography and endoscopic sphincterotomy versus conservative treatment for acute pancreatitis due to gallstones. Lancet. 1988; 2(8618): 979–983.
- Rau B, Pralle U, Mayer JM, et al. Role of ultrasonographically guided fine-needle aspiration cytology in the diagnosis of infected pancreatic necrosis. Br J Surg. 1998; 85(2): 179–184.
- Röder PV, Wu B, Liu Y, et al. Pancreatic regulation of glucose homeostasis. Exp Mol Med. 2016; 48(3): e219.
- Schröder T, Sainio V, Kivisaari L, et al. Pancreatic resection versus peritoneal lavage in acute necrotizing pancreatitis. A prospective randomized trial. Ann Surg. 1991; 214(6): 663–666.
- Suda K, Nobukawa B, Takase M, et al. Pancreatic segmentation on an embryological and anatomical basis. J Hepatobiliary Pancreat Surg. 2006; 13(2): 146–148.
- Teerenhovi O, Nordback I, Eskola J. High volume lesser sac lavage in acute necrotizing pancreatitis. Br J Surg. 1989; 76(4): 370–373.
- Uhl W, Warshaw A, Imrie C, et al. IAP Guidelines for the surgical management of acute pancreatitis. Pancreatology. 2002; 2(6): 565–573.
- Wang GJ, Gao CF, Wei D, et al. Acute pancreatitis: etiology and common pathogenesis. World J Gastroenterol. 2009; 15(12): 1427–1430.
- Weiss FU, Laemmerhirt F, Lerch MM. Etiology and risk factors of acute and chronic pancreatitis. Visc Med. 2019; 35(2): 73–81.
- Wu X, Zheng R, Lin H, et al. [Effect of transpulmonary pressure-directed mechanical ventilation on respiration in severe acute pancreatitis patient with intraabdominal hypertension]. Zhonghua Yi Xue Za Zhi. 2015; 95(39): 3168–3172.
- Zhou Q, Melton D. Pancreas regeneration. Nature. 2018; 557(7705): 351–358.
