Indications for surgery in severe acute pancreatitis
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The decision to operate on a patient with severe acute pancreatitis is often difficult and requires mature clinical judgment. Those indications that are widely accepted include:
For differential diagnosis, when the surgeon is concerned that the symptoms are the result of a disease other than pancreatitis for which operation is mandatory;
In persistent and severe biliary pancreatitis, when an obstructing gallstone that cannot be managed endoscopically is lodged at the ampulla of Vater;
In the presence of infected pancreatic necrosis; and
To drain a pancreatic abscess, if percutaneous drainage does not produce the desired result.
Other indications that are less well defined and somewhat controversial are:
The presence of sterile pancreatic necrosis involving 50% or more of the pancreas;
When the pancreatitis persists in spite of maximal medical therapy; and
When the patient’s condition deteriorates, often with the failure of one or more organ systems.
For these latter three indications, guidelines have been presented that permit a logical approach to management, although uncertainty remains. Surgeons should strive to describe in precise terms the clinical state of their patients at the time that operation is performed, as well as the findings at and technical details of the surgery. This should allow further refinement in the management of this still vexing problem.
- Moynihan B. Acute pancreatitis.Ann Surg 1925; 81: 132–138.
- Elman R, McCaughan JM. Quantitative determination of blood amylase with viscometer.Arch Int Med 1927; 40: 58–64.
- Geokas MC, Vanlacker JL, Kadell BM, Machleder HI. Acute pancreatitis.Ann Intern Med 1972; 76: 105–112.
- Martin JK, van Heerden JA, Bess MA. Surgical manage- ment of acute pancreatitis.Mayo Clin Proc 1984; 59: 259–270.
- Ferguson CM, Bradley EL. Can markers for pancreatic necrosis be used as indicators for surgery?Am J Surg 1990; 160: 459–463. CrossRef
- Block S, Buchler M, Bittner R. Sepsis indicators in acute pancreatitis.Pancreas 1987; 2: 499–505. CrossRef
- Banks PA. Editorial: Sepsis indicators in acute pancreatitis.Pancreas 1987; 2: 497–498. CrossRef
- Ranson JHC, Rifkind KJM, Roses DF. Objective early identification of severe acute pancreatitis.Am J Gastroenterol 1974; 61: 443–451.
- Larvin M, McMahon MJ. APACHE II score for assessment and monitoring of acute pancreatitis.Lancet 1989; 2: 201–205. CrossRef
- Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: A severity of disease classification system.Crit Care Med 1985; 13: 818–829. CrossRef
- Bradley El, Murphey F, Ferguson C. Prediction of pancreatic necrosis by dynamic pancreatography.Ann Surg 1989; 210: 495–504, CrossRef
- Freeny PC. Incremental dynamic bolus computed tomography of acute pancreatitis—state of the art.Int J Pancreatology 1993; 13: 147–158.
- Balthazar El, Robinson DL, Megibow AJ, Ranson JHC. Acute pancreatitis: value of CT in establishing prognosis.Radiology 1990; 174: 331–337.
- Ranson JHC. The role of surgery in the management of acute pancreatitis.Ann Surg 1990; 211: 382.
- Poston GJ, Williamson RCN. Surgical management of acute pancreatitis.Br J Surg 1990; 77: 5. CrossRef
- Rattner DW, Warshaw AL. Surgical intervention in acute pancreatitis.Crit Care Med 1988; 16: 89. CrossRef
- Osborne DH, Imrie CW, Carter DC. Biliary surgery in the same admission for gallstone associated acute pancreatitis.Br J Surg 1981; 68: 758–761. CrossRef
- Fan St, Lai ECS, Mok FPT, Lo CM, Zheng SS, Wong J, Early treatment of acute biliary pancreatitis by endoscopic papillotomy.New Engl J Med 1993; 328: 228–233. CrossRef
- Banks PA. The role of needle-aspiration bacteriology in the management of necrotizing pancreatitis, inAcute Pancreatitis: Diagnosis and Therapy, Bradley EL III, ed. New York, Raven, 1993; pp. 99–104.
- Bradley EL A clinically based classification system for acute pancreatitis.Arch Surg 1993; 128: 586–592.
- Beger HG, Krautzberger W, Bittner R, Block S, Buchler M. Results of surgical treatment of necrotizing pancreatitis.World J Surg 1985; 9: 972–979. CrossRef
- Beger HG, Buchler M, Bittner R, Block S, Nevalainen T, Roscher R. Necrosectomy and postoperative lavage in necrotizing pancreatitis.Br J Surg 1988; 75: 207–216. CrossRef
- Bradley EL III, Allen KA. Management of necrotizing pancreatitis: results of prospective longitudinal trial.Am J Surg 1991; 161: 19–25. CrossRef
- Reber HA. Editorial: Surgical intervention in necrotizing pancreatitis.Gastroenterology 1986; 91: 479–482.
- Buchler M, Uhl W, Isenmann R, Bittner R, Beger HG. Necrotizing pancreatitis: necrosectomy and closed continuous lavage of the lesser sac. The Ulm experience, inStandards in Pancreatic Surgery, Beger HG, Buchler M, Malfertheiner P, eds. Springer, Berlin, 1993; 191–202.
- McFadden DW. Organ failure and multiple organ system failure in pancreatitis.Pancreas 1991; 6: S37–44. CrossRef
- Fry DE. Multiple organ system failure.Surg Clin N Am 1988; 68: 107–122.
- Warshaw Al, Gongliang OJ. Improved survival in 45 patients with pancreatic abscess.Ann Surg 1985; 120: 690–702.
- Karimgani I, Porter KA, Langevin RE, Banks PA. Prognostic factors in sterile pancreatic necrosis.Gastroenterology 1992; 103: 1636–1640.
- Carrico CJ, Meakins JL, Marshall JC. Multiple organ failure syndrome.Arch Surg 1986; 121: 196–208.
- Bradley EL III. Open packing for infected pancreatic necrosis, inStandards in Pancreatic Surgery, Beger HG, Buchler M, Malfertheiner P, eds. Springer, Berlin 1993; 220–232.
- Indications for surgery in severe acute pancreatitis
International Journal of Pancreatology
Volume 15, Issue 2 , pp 83-90
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- Humana Press
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- Acute pancreatitis
- surgical intervention
- biliary pancreatitis
- pancreatic necrosis
- pancreatic abscess
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