The surgical approach to acute necrotizing pancreatitis treatment
The aim of this work was to estimate the efficiency of the proposed surgical treatment for acute necrotizing pancreatitis. Materials and Methods: We analyzed the outcomes of the treatment of 317 patients with acute necrotizing pancreatitis in whom the proposed surgical treatment was used over the period of 2013-2019. The new postoperative onset of organ failure, duration of intensive care treatment, postoperative complications, and mortality rates was studied. Results and Discussion: We used the step-up approach to surgical treatment, which started from either diapeutic transcutaneous ultrasound-guided procedures in 48.2 % and endoscopic ultrasound-guided - in 46.2 % of cases. Transcutaneous procedures were followed by less complication rate in acute necrotic collection cases whereas endoscopic operations - in walled-off pancreatic necrosis patients. Wide laparotomic necrosectomies were applied in 14.5 % of patients after the 4th week of the disease onset. The overall mortality rate was 3.5 %, and after the surgical treatment - 6.5 %. Application of step-up surgical treatment in patients with ANP decreases the need to perform wide laparotomic necrosectomies and reduces the rate of postoperative complications.