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Relevance The tactics of fluid collections management in acute pancreatitis is controversial. Evaluation of treatment results based on unified classification criteria will allow to define more clearly the indications for various surgical procedures in these patients. Aim. Analysis of the results of treatment of patients with fluid collections in acute pancreatitis according to the revised Atlanta classification. Materials and methods 109 patients with acute pancreatitis and fluid collections formation were divided according to the revised Atlanta criteria (2012). Interstitial pancreatitis was in 7 patients, necrotizing pancreatitis – in 102. Acute peripancreatic fluid  collections were in 5 cases, pancreatic pseudocysts – in 2. Acute necrotic collections were in 93 persons. 9 patients were admitted with walled-off necrosis. Indications for surgery were suppuration of fluid collections, in absence of pancreatic infection – persistence of pain, rapid growth of the volume of the collections. Comparison of the groups was performed using two-tailed Fisher's exact p, χ2 test, the level of significance of differences was ≤0.05. Results. Conservative treatment in interstitial pancreatitis resulted in regression of fluid collections in 2 cases including pancreatic pseudocyst, a significant reduction in the size – in 2 cases. External drainage led to resorption of peripancreatic fluid collections in 2 patients, the recurrence of the pancreatic pseudocyst happened after removal of a drainage. Conservative treatment in acute necrotic collections resulted in their regression in 20% patients, formation of the walled-off necrosis – in 40%, suppuration or rapid growth of the volume – in 36%, reduction in the size – in 4%. External drainage of acute necrotic collections using real time ultrasound (US) guidance was performed in 16 patients, by means of open access – in 17. The comparison of the results of US-guided drainage and opened procedures did not reveal significant differences in lethality (р=0.224) and regression rate (р=0.728). Walled-off necrosis (46) was drained by open extraperitoneal access in 12 patients, by US-guidance – in 10. The regression rate was higher in open surgery compared to US-drainage (p=0.027). Conservative treatment in 24 patients with walled-off necrosis (52%) resulted in stabilization or decrease in size of the collection, pain and inflammation signs disappearance; of these walled-off necrosis regressed in period of 4 months to 1 year in 8 patients. Conclusions. Formation of fluid collections in acute pancreatitis requires continued conservative measures. Surgical treatment is indicated in most of cases in suppuration. External US-guided drainage is preferred for acute necrotic collections. In walled-off necrosis open extraperitoneal drainage is more effective. Key words: acute pancreatitis, fluid collections, conservative treatment, ultrasound-guided drainage, open extraperitoneal access.

Tactical Issues of Treatment of Fluid Collections According to the Revised Atlanta Classifiction of Local Complications of Acute Pancreatitis