Surgical and Interventional Management and its Outcome in Severe Acute Pancreatitis

Abstract

Background: Acute pancreatitis is an acute inflammation of the pancreas resulting from an auto-digestion of the gland. Acute pancreatitis represents a spectrum of disease ranging from a mild, self-limited course to a rapidly progressive, severe illness. In 20–25% of acute pancreatitis are severe, characterized by the development of pancreatic or peri-pancreatic necrosis, resulting in general and local complications responsible for a high mortality rate. The most common indication for intervention in acute pancreatitis is for the treatment of complications and most notably the treatment of infected walled off necrosis. Aims: The aim is to study the intervention to surgery and its outcome in managing severe acute pancreatitis and its complications. Methods: A total of 36 patients with severe acute pancreatitis with its complications not responding to conservative treatment were studied. In this prospective observational study, patients were divided based on the mode of treatment received: percutaneous drainage with pigtail catheterisation, endoscopic cystogastrostomy/drainage procedure and necrosectomy (in patient failed to respond by other intervention). Results: In our study, out of 36 patient 22 patient are treated with percutanous drainage with pig tail catheterization,8 patient are treated with endoscopic cystogastrostomy,6 patient underwent necrosectomy (3 patient underwent minimally invasive laparoscopic necrosectomy and 3 underwent open necrosectomy).Higher complication occured in patient underwent surgical intervention.Mortality occurred in 80% of patient who underwent necrosectomy. Most common cause of death is sepsis with multi organ failure. Conclusion: Surgeons have an important contribution to make in the multidisciplinary care of patients with complicated acute pancreatitis .Patients with acute pancreatitis should be managed conservatively in a step up approach. Early surgical intervention is not recommended even for necrotizing pancreatitis. Infected..