[Acute necrotizing pancreatitis: therapeutic alternatives]. / Pancreatitis aguda grave: alternativas terapéuticas.

The management of acute necrotizing pancreatitis has changed significantly over the last few years. Currently, most patients survive the early phases of the disease due to improvements in intensive care unit management. The most important risk factor for morbidity and mortality is infection of the pancreatic necrosis. Ideally, surgery should be delayed until 4 weeks after the onset of symptoms of pancreatitis, as it is at this time that the necrosis is most clearly demarcated. Advances in diagnostic imaging and minimally invasive techniques in surgery and radiology have revolutionized the surgical management of this disease. However, minimally invasive techniques should be limited to critically-ill patients unfit for conventional surgery.

Pancreatitis aguda grave: alternativas terapéuticas / Acute necrotizing pancreatitis: therapeutic alternatives

El tratamiento de la pancreatitis aguda grave ha cambiado de manera significativa en los últimos años. Actualmente, la mayoría de los pacientes sobrevive a la primera etapa de la pancreatitis grave debido a una mejoría al tratamiento en la unidad de cuidados intensivos. Respecto a la morbimortalidad, la infección pancreática es el factor de riesgo más importante. La cirugía debe de ser idealmente pospuesta unas 4 semanas después del inicio de la sintomatología, ya que es en este tiempo cuando la necrosis se encuentra claramente demarcada. Los avances en el diagnóstico por imagen, el desarrollo de la radiología intervencionista y las intervenciones por acceso mínimo han revolucionado el tratamiento quirúrgico; sin embargo, estas técnicas de acceso mínimo para el tratamiento de la necrosis pancreática infectada deben de estar limitados únicamente a pacientes en estado crítico que no se encuentren en condiciones para ser sometidos a los procedimientos de cirugía convencional (AU)

The management of acute necrotizing pancreatitis has changed significantly over the last few years. Currently, most patients survive the early phases of the disease due to improvements in intensive care unit management. The most important risk factor for morbidity and mortality is infection of the pancreatic necrosis. Ideally, surgery should be delayed until 4 weeks after the onset of symptoms of pancreatitis, as it is at this time that the necrosis is most clearly demarcated. Advances in diagnostic imaging and minimally invasive techniques in surgery and radiology have revolutionized the surgical management of this disease. However, minimally invasive techniques should be limited to critically-ill patients unfit for conventional surgery (AU)