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Surgery for Acute Pancreatitis

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Abstract

Surgery for acute pancreatitis has undergone significant changes over the last 3 decades. A better understanding of the pathophysiology has contributed to this, but the greatest driver for change has been the rise of less invasive interventions in the fields of laparoscopy, endoscopy and radiology. Surgery has a very limited role in the diagnosis of acute pancreatitis. The most common indication for intervention in acute pancreatitis is for the treatment of complications and most notably the treatment of infected walled off necrosis. Here, the step-up approach has become established, with prior drainage (either endoscopic or percutaneous) followed by delay for maturing of the wall and then debridement by endoscopic or minimally invasive surgical methods. Open surgery is only indicated when this approach fails. Other indications for surgery in acute pancreatitis are for the treatment of acute compartment syndrome, non-occlusive intestinal ischaemia and necrosis, enterocutaneous fistulae, vascular complications and pseudocyst. Surgery also has a role in the prevention of recurrent acute pancreatitis by cholecystectomy. Despite the more restricted role, surgeons have an important contribution to make in the multidisciplinary care of patients with complicated acute pancreatitis.

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Authors and Affiliations

  1. Hepatopancreatobiliary / Upper GI Unit, Auckland City Hospital, Park Road, Grafton, Auckland, New Zealand

    Suresh Navadgi, Sanjay Pandanaboyana & John A. Windsor

  2. Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Victoria Street West, Auckland, 1142, New Zealand

    Sanjay Pandanaboyana & John A. Windsor

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  1. Suresh Navadgi
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  2. Sanjay Pandanaboyana
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  3. John A. Windsor
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Correspondence to John A. Windsor.

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Navadgi, S., Pandanaboyana, S. & Windsor, J.A. Surgery for Acute Pancreatitis. Indian J Surg 77, 446–452 (2015). https://doi.org/10.1007/s12262-015-1357-x

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