JPN Guidelines for the management of acute pancreatitis:surgical management

Abstract

surgical intervention should be performed only in selected cases, such as those with persistent organ complications or severe clinical deterioration despite maximum intensive care; (4) early surgical intervention is not recommended for necrotizing pancreatitis; (5) necrosectomy is recommended as the surgical procedure for infected pancreatic necrosis; (6) simple drainage should be avoided after necrosectomy, and either continuous closed lavage or open drainage should be performed; (7) surgical or percutaneous drainage should be performed for pancreatic abscess; (8) pancreatic abscesses for which clinical findings are not improved by percutaneous drainage should be subjected to surgical drainage immediately; (9) pancreatic pseudocysts that produce symptoms and complications or the diameter of which increases should be drained percutaneously or endoscopically; and (10) pancreatic pseudocysts that do not tend to improve in response to percutaneous drainage or endoscopic drainage should be managed surgically. Key words

Practical Guidelines for Acute Pancreatitis

“…Answer: Surgical or percutaneous drainage should be performed for a pancreatic abscess (recommendation C) [19]. If the clinical findings of a pancreatic abscess are not improved by percutaneous drainage, surgical drainage should be performed immediately (recommendation B) [19].…”

“…We included 21 publications which fulfilled the inclusion criteria and addressed the clinical questions of this analysis [1,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27]. Each of these publications was independently and thoroughly reviewed by the panel of experts.…”

“…Answer: Necrosectomy is recommended as the optimal surgical procedure for infected pancreatic necrosis (recommendation A) [19]. …”

“…If the clinical findings of a pancreatic abscess are not improved by percutaneous drainage, surgical drainage should be performed immediately (recommendation B) [19]. …”

“…The participants of the AISP working group selected nine [12,15,16,18,19,20,21,22,23] of the 21 guidelines, basing their judgment on the ADAPTE procedure [4]. …”