Vnitr Lek 2002, 48(9):856-860

[Acute pancreatitis from the aspect of the surgeon].

J Wechsler, J Zák, D Wechsler: I. Chirurgická klinika Lékarské fakulty MU a FN u sv. Anny, Brno.

The authors provide evidence of the extreme increase of the frequency of acute pancreatitis. At the First Surgical Clinic in Brno in 1934 the frequency of acute pancreatitis (AP) was 0.2 pro mille (in the course of 3 years 4 patients among 20 000 hospitalized patients), at present (65 years later) in 1999 - 2001 it is 0.7%--74 patients among 10 676 hospitalized patients. This is 35 times more, 48 men (65%) and 26 women (35%). The mean age was 48.6 years, range 26 - 83 years. The lethality of the whole group was 9.5%. From the total number of 74 patients seriously ill patients (Atlanta II classification) 25 patients--34%, Atlanta I--49 patients--66%. 7 patients with acute necrotizing infected pancreatitis died--28% of the whole group. Initial treatment of AP is based on adherence to three principles:(a) intensive treatment, (b) elimination of etiological factors and (c) control of complications. Contrary to other affectios in AP, there is no specific surgical treatment. Indications for surgical treatment of AP: I. early stage--explorative laparotomy if stabilization of patient by adequate treatment to resolve comorbidity (NPB etc.) is impossible, II. advanced stage--evacuation of infected necroses, abscesses, infected or bleeding pseudocyst, elective sanation of biliary tract. The optimal timing is between the 2nd and 3rd week of the disease. Premature surgery does not have a favourable effect on the subsequent course of the disease.