SEVERE ACUTE PANCREATITIS: OPTIONS OF TACTICAL APROACHES TO TREATMENT

Abstract. Introduction. Severe acute pancreatitis still remains a pressing issue of urgent abdominal surgery. Aim: To provide a multifactorial analysis of managing patients with severe acute pancreatitis and assess the efficiency of the treatment approaches used. Materials and Methods. Our study included 94 patients with severe acute pancreatitis, aged 30 to 76 years (average age 48.6+10.1), admitted to Surgery Departments 1 and 2 of Kazan City Clinical Hospital 7 over the last 10 years. There were 58 (61.7 %) male patients and 36 (38.3 %) female patients. We did not include patients with severe comorbid diseases, pregnant patients, drug addicts, or those refusing to be involved in our study. Extremely severe, fulminant forms of acute pancreatitis were also excluded, namely: SOFA ≥ 7 and/or intraabdominal pressure >25 mm Hg persisting after 48 hours from the onset of the disease. 30 (31.9%) patients were admitted within the first 24h, 44 (46.8%) patients within 24-72h, and 20 (21.3%) within 3-5 days upon the onset. Examination of the patients included clinical, laboratory, and imaging approaches. We used conservative methods, such as massive infusions, epidural block, and parenteral feeding with gradually changing into enteral feeding. Minimal invasive approaches were used, such as laparoscopy, ultrasound-controlled liquid inclusions drainage, and endoscopic main pancreatic duct stenting. Transabdominal and extraperitoneal open surgeries were performed, as well. The findings were evaluated statistically using Statistica 6.0. In evaluating nonparametric values, we calculated criterion χ2 (chi-squared test). Differences in the results were considered statistically significant at p<0.05. Results and Discussion. Our analysis of current approaches to the treatment of severe acute pancreatitis showed benefits of intensive care combined with minimal invasive surgery performed at the onset of the disease. This allowed increasing the patients’ survival rates to 81.9 % and reducing mortality to 18.1 %. Conclusions. Unsatisfactory treatment outcomes of severe acute pancreatitis are mostly caused by inaccurate evaluation of the disease severity at admission and, therefore, delayed initiation of intensive care.