Acute Severe Pancreatitis Intra and Early Post Open Packing Operation Complications

Abstract


Relevance The need to determine the frequency of occurrence of a speciŸc type of complication of "open" operations in severe
pancreatitis, the timeliness of their recognition, the deŸnition of the indications for surgical or conservative treatment of intraoperative
and early postoperative complications, the choice of surgical methods, the development of principles of postoperative management
and rehabilitation of such patients.
The purpose of the study Was to improve the results of the use of "open" surgery in patients with acute severe pancreatitis.
Materials and Methods 6844 patients with acute pancreatitis were under surveillance for the last 20 years. 493 (7,3%) of them
underwent surgical treatment. 322 had an "open" operative intervention, and in 102 (31.6%) identiŸed 197 intraoperative or
early postoperative complications. Lien trauma was revealed intraoperationally with 7 patients, 3 cyst bleeding after dissection, 1
splenic artery bleeding and 1 parenchymal splenic bleeding. Among the early postoperative complications were revealed: arrosive
hemorrhage 30,8%; pancreatic Ÿstulas 19,1%; hollow organ Ÿstulas – stomach 7,4%, duodenum 5,3%, small intestine 3,2%, colon
12,7%, cystoduodenal Ÿstulas 2,1%, stomach phlegmon 2,1%, acute cholecystitis 1,06%, trombotic complications 3,2%, purulent
pleuritis 1,06%.
Results and their discussion The main reason for acute severe pancreatitis intra and early post open packing operation complications
are the inŸltration process on the intervention area, the involvement of the hollow organ wall into the purulent process, vessel
deformation and the destruction of the pancreatic duct disruption. The primary prophylactic measures of the complications are
adequate access, certain intraoperative tissue differentiation, unconŸned sequestrum elimination without force, the rejection of
the acute removal of the necrotic tissues and the sanation relaparotomy with the application of local anesthesia each 48-72 hours.

The treatment tactics of the open packing operation complications is quite diversiŸed and can be either conservative or operative, palliative or resective and depend on the local changes in the intervention area and polyorganic deŸciency presence.

Conclusion The results of the treatment “open” packing operations complications in severe acute pancreatitis are achieved through 

the use of our clinical guidelines developed in the management of patients with severe acute pancreatitis in all phases of treatment.

 


i.m. sechenov First moscow state medical university, moscow, russian Federation Clinical hospital № 53, moscow, russian Federation

Author for correspondence.
Email: mail@vestnik-surgery.com

MD, professor of surgery, Faculty of
postgraduate professional training of physicians,
sechenov First Moscow state medical university

i.m. sechenov First moscow state medical university, moscow, russian Federation Clinical hospital № 53, moscow, russian Federation

Email: mail@vestnik-surgery.com

Phd, assistant in the department of
surgery, Faculty of postgraduate professional training
of physicians, sechenov First moscow state medical
university

i.m. sechenov First moscow state medical university, moscow, russian Federation Clinical hospital № 53, moscow, russian Federation

Email: mail@vestnik-surgery.com

postgraduate, Chair of surgery, Faculty
of postgraduate professional training of physicians,
sechenov First moscow state medical university

i.m. sechenov First moscow state medical university, moscow, russian Federation Clinical hospital № 53, moscow, russian Federation

Email: mail@vestnik-surgery.com

postgraduate, Chair of surgery, Faculty
of postgraduate professional training of physicians,
sechenov First moscow state medical university

i.m. sechenov First moscow state medical university, moscow, russian Federation Clinical hospital № 53, moscow, russian Federation

Email: mail@vestnik-surgery.com

surgeon of the clinical hospital № 53,
moscow

i.m. sechenov First moscow state medical university, moscow, russian Federation Clinical hospital № 53, moscow, russian Federation

Email: mail@vestnik-surgery.com

surgeon of the clinical hospital № 53,
moscow

i.m. sechenov First moscow state medical university, moscow, russian Federation Clinical hospital № 53, moscow, russian Federation

Email: goonar@list.ru

Faculty of postgraduate
professional training of physicians, chair of surgery,
sechenov First moscow state medical university.,
resident of doctor

i.m. sechenov First moscow state medical university, moscow, russian Federation Clinical hospital № 53, moscow, russian Federation

Email: doc-abramov@yandex.ru

chief of Department of intensive
Care, clinical hospital № 53, moscow

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