Acute Pancreatitis. Results of Surgical Treatment

Abstract


The purpose of the study To analyze the results of the treatment of patients with acute destructive pancreatitis and determine the most effective methods of various drainage operations to decrease the number of complications and mortality rates as well as improve treatment outcomes. Materials and methods The results of the treatment of 1433 patients, among whom 136 (9,5%) had various forms of acute destructive pancreatitis, were analyzed. The basic complex conservative therapy during the study period was consistent and included antisecretory, infusion, antiulcer, antibacterial, corrective therapy, extracorporeal detoxification methods. At admission, the general condition of 49 patients (36,3%) was viewed as moderate, of 46 patients (34,2%) – as serious and of 33 patients (24,5%) – as extremely difficult. Results and their discussion In case of primary destruction of the pancreatic tissue and parapancreatic cellulose of less than 30%, conservative therapy, extracorporeal detoxification methods along with minimally invasive surgery proved to be effective in 91,1% of the cases. In 8,9% of the cases, additional minimally invasive "closed" drainages of the local suppurative complications were required. The prolonged epidural analgesia was applied to all patients during the complex treatment, regardless of the number of destructive changes and severe course of the disease, starting from the first days. The general stages of surgical intervention for patients with severe acute destructive pancreatitis during the early development of both aseptic as well as early and late unlimited postnecrotic septic complications were developed. Conclusion A differentiated approach to the surgical treatment strategy of the patients with destructive pancreatitis, depending on the amount of the initial lesion of the pancreas, allowed to reduce the average number of suppurative complications by 4 times per patient (from 9,8 to 2,2%) and decrease the mortality rates by 3 times from suppurative complications.

City Clinical Hospital № 23 named Medsantrud, Moscow, Russian Federation

Author for correspondence.
Email: Valeriy20132@gmail.com
MD, Prof. of the Department of General Surgery of the First Moscow State Medical University named after I.M.Sechenov

I.M.Sechenov First Moscow State Medical University, Moscow, Russian Federation

Email: afansurg@rambler.ru
MD, Prof. of the Department of General Surgery of the First Moscow State Medical University named after I.M.Sechenov, Head. 3rd Surgical Department 23 City Clinical Hospital. Medsantrud

I.M.Sechenov First Moscow State Medical University, Moscow, Russian Federation

Email: author@vestnik-surgery.com
Head. Intensive Care Unit 23 City Clinical Hospital. Medsantrud

I.M.Sechenov First Moscow State Medical University, Moscow, Russian Federation

Email: author@vestnik-surgery.com
Ph.D., ass. Department of General Surgery of the First Moscow State Medical University. Sechenov, a surgeon third surgical unit 23 of the City Clinical Hospital. Medsantrud

I.M.Sechenov First Moscow State Medical University, Moscow, Russian Federation

Email: author@vestnik-surgery.com
MD, ass. Department of General Surgery of the First Moscow State Medical University. Sechenov, a surgeon third surgical unit 23 of the City Clinical Hospital Medsantrud

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