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Current Treatment Options in Gastroenterology

, Volume 6, Issue 5, pp 359–367 | Cite as

Surgical treatment of acute pancreatitis

  • Jens Werner
  • Waldemar Uhl
  • Markus W. Büchler
Article

Opinion statement

Patients with predicted severe necrotizing pancreatitis as diagnosed by C-reactive protein (>150 mg/L) and/or contrast-enhanced computed tomography should be managed in the intensive care unit. Prophylactic broad-spectrum antibiotics reduce infection rates and survival in severe necrotizing pancreatitis. Endoscopic retrograde cholangiopancreatography and endoscopic sphincterotomy is a causative therapy for gallstone pancreatitis with impacted stones, biliary sepsis, or obstructive jaundice. Fine needle aspiration for bacteriology should be performed to differentiate between sterile and infected pancreatic necrosis in patients with sepsis syndrome. Infected pancreatic necrosis in patients with clinical signs and symptoms of sepsis is an indication for surgery. Patients with sterile pancreatic necrosis should be managed conservatively. Surgery in patients with sterile necrosis may be indicated in cases of persistent necrotizing pancreatitis and in the rare cases of “fulminant acute pancreatitis.” Early surgery, within 14 days after onset of the disease, is not recommended in patients with necrotizing pancreatitis. The surgical approach should be organ-preserving (debridement/necrosectomy) and combined with a postoperative management concept that maximizes postoperative evacuation of retroperitoneal debris and exudate. Minimally invasive surgical procedures have to be regarded as an experimental approach and should be restricted to controlled trials. Cholecystectomy should be performed to avoid recurrence of gallstone-associated acute pancreatitis.

Keywords

Pancreatitis Acute Pancreatitis Severe Acute Pancreatitis Pancreatic Necrosis Endoscopic Sphincterotomy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© Current Science Inc 2003

Authors and Affiliations

  • Jens Werner
    • 1
  • Waldemar Uhl
    • 1
  • Markus W. Büchler
    • 1
  1. 1.Department of General and Visceral SurgeryUniversity of HeidelbergHeidelbergGermany

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