Acute pancreatitis surgery

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Raviteja Guddeti, M.B.B.S. [2]

Overview

Surgery in the treatment of acute pancreatitis is indicated for infected pancreatic necrosis, in cases of diagnostic uncertainty and in the presence of complications.

Surgery

Surgery is indicated for

1. Infected pancreatic necrosis
2. Diagnostic uncertainty
3. Complications.

The most common cause of death in acute pancreatitis is secondary infection. Infection is diagnosed based on 2 criteria:

• Gas bubbles on CT scan (present in 20 to 50% of infected necrosis)
• Positive bacterial culture on FNA (fine needle aspiration, usually CT or US guided) of the pancreas.

Surgical options for infected necrosis include:

• Conventional management - necrosectomy with simple drainage
• Closed management - necrosectomy with closed continuous lavage
• Open management - necrosectomy with planned staged reoperations at definite intervals (up to 7 reoperations in some cases)