Concerns relating the surgical management of severe acute pancreatitis / 中华消化外科杂志

ABSTRACT

Nowadays,some new characteristics emerge in the modem management of severe acute pancreatitis (SAP),such as minimally invasive,staging,multidisciplinary,specialized and diversified.There is a prevalent insufficiency in the surgical management of SAP due to various reasons.A precise grasp of timing,indication and manner in the surgical management of SAP is of great importance to further improve the curative rate.Surgical intervention of SAP is performed in a staged step-up framework,which should not only be indicated by infectious complications in the late-phase of SAP,but also by a failure of nonsurgical therapy and a progression to abdominal compartment syndrome and/or multiple organ failure (MOF) in the earlyphase of SAP.In a staged step-up framework,imaging-guided percutaneous catheter drainage could be established relatively early,MOF and heterogeneous collection are independent risk factors of the necessity of surgical debridement,and the merits of open debridement should not be under-estimated.A sameadmission cholecystectomy could be arranged for patients with gallstone SAP,and laparoscopic cholecystectomy serves as the initial choice.In the context of minimal-invasiveness and diversification,the surgeons should endeavor to establish their predominant role in the multidisciplinary team,preventing from insufficient surgical intervention in the management of SAP.