Title: Current treatments in acute pancreatitis: surgical considerations
- Alfredo F. Tonsi, Claudio Bassi
- Editorial article
- Polish Gastroenterology
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- acute pancreatitis, infected necrotizing pancreatitis (INP), systemic inflammatory response syndrome (SIRS), surgery, necrosectomy, minimal access surgery, natural orifice transluminal endoscopic surgery (NOTES)
Acute pancreatitis is an acute inflammatory disease of the pancreas which can lead to a systemic inflammatory response syndrome (SIRS) with a significant morbidity and mortality in 20% of patients. The aim of this paper was to discuss advances in treatment of acute pancreatitis focusing particularly on surgical strategies for treatment of infected necrotizing pancreatitis (INP). Surgery should be postponed 4 weeks after the onset of symptoms. Since traditional open surgery carries a high mortality, the last 2 decades have seen a wider use of less invasive techniques including radiological or endoscopical (natural orifice transluminal endoscopic surgery - NOTES) drainage and minimal access surgery. Although the results in terms of morbidity and mortality of these less invasive techniques are encouraging, there is no international consensus about the optimal surgical strategy. While infected necrotizing pancreatitis is a complex and heterogeneous disease, retrospective controlled trials (RCTs) comparing the different strategies have never been published and are still waiting.