SURGICAL TREATMENT OF LOCAL PURULENT-SEPTIC COMPLICATIONS OF ACUTE SEVERE PANCREITIS

In the past decades, mortality in acute pancreatitis ranges from 3 to 15 % and depends mainly on the specific weight of severe forms of morbidity, which is characterized by the development of necrotic processes in the pancreas and systemic complications. Despite the large number of studies on severe forms of acute pancreatitis, a significant improvement of results of treatment of this category of patients is not observed. The integrated diagnosis and treatment of this pathology, prognosis and prevention of purulentseptic complications are relevant today. The aim of the study was to evaluate the effectiveness of surgical tactics depending on the nature and prevalence of local purulent-septic complications of acute pancreatitis. To solve this problem, the results of treatment were analyzed the results of treatment of 422 patients with acute pancreatitis who were treated in the surgical Department of the Poltava regional clinical hospital in the period from 2010 to 2015. All patients were admitted to hospital for 1-7 days after infection. 315 (74.6 %) of them are diagnosed as having acute pancreatitis easy, patients received conservative therapy and 7-10 days was discharged from the hospital. Moderate and severe pancreatitis with the development of local parapancreatic complications were diagnosed in 107 patients (25, 4%), 67 (62.6%) men and 40 (37, 4%) women. Their age ranged from 22 to 81 years (47, 9±1.5 years). The severity of the patients was determined by the BISAP scale, the presence of organ failure was diagnosed by applying the Marshal scale (modification 2012) [5]. The patients were examined according to the order Ministry of Healthcare of Ukraine № 297 dated 2 April 2010. Moderate acute pancreatitis is characterized by localization of purulent-septic complications in 12 anatomical areas with a predominantly liquid component. Severe acute pancreatitis is characterized by the localization of purulent-septic complications in more than 2 anatomical sites with primarily tissular component. Efficacy of simple drainage procedures depended on the incidence of fluid accumulations in the 1-2 anatomical region and presence of a predominantly liquid component. Among the patients with predominant tissue component in the liquid accumulation and the prevalence of local parapancreatic complications in more than two anatomic sites, the performance of open necrosectomy seems to be the most appropriate.