Surgical intervention of acute necrotizing pancreatitis: timing is more important than technology / 中华消化外科杂志

ABSTRACT

At present, around the surgical and non-surgical treatment of acute necrotic pancreatitis, early surgery or late surgery, minimally invasive intervention or open surgery, consensus is gradually formed. Further exploring the optimal surgical timing and surgical techniques for the debridement, combination of the surgical and minimally invasive intervention strategies, and improving the success rate of delayed one-time surgical intervention is the key to further reduce the mortality rate of acute necrotic pancreatitis of the late stage. In the past two decades, the treatment mode of the late stage of acute necrotic pancreatitis had been changed extremely as the understanding of the pathology of local complications of acute necrosis pancreatitis has been deepened. From the early open surgery for abdominal decompression in the late 20th century to the planned multiple surgical debridement, and then to the postponement one-time surgery, as well as the development of step-up approach procedures in recent years, changement in the concept of treatment gradually achieved a breakthrough in efficacy. Compared with the techniques of different procedures for necrotic tissues, the choice of surgical timing is more important to the success of treatment. From the evidence-based results of existing studies of acute necrotic pancreatitis, it is not possible to determine the advantages of surgical techniques to improve the prognosis due to the complexity of acute necrotic pancreatitis, individual differences and limited results from multicenter research. The proper timing of surgery is indisputable in the role of improving the surgical effect of acute necrosis pancreatitis. The author reviews the clinical data of more than 1, 000 patients treated by the analytical team for the treatment of acute necrotic pancreatitis, and discusses the timing of surgical intervention and the clinical significance of technology for improving prognosis for the late stage of acute necrotic pancreatitis.