Surgical and intervention treatment of secondary pancreatic infections

. Many experimental and clinicalstudies have improved our understanding of thepathophysiology of acute pancreatitis. Today, thereare no disagreements over the timing and basicindications for surgery in this disease, but there arestill various surgical approaches.Methods. A retrospective and prospective twocentercontrolled study was conducted in 582 patientswith acute pancreatitis treated in 2004–2018. Age ofpatients was 53 ± 12,5 years. The classification of thedisease was used according to the recommendationsof the International Consensus 2012. Patientsincluded in the study were treated in accordancewith the IAP/APA (2013) recommendations adaptedto local resources and procedures. Of 582 patients,387 (66,5%) patients with mild to moderate heavinessperformed complex treatment, including 89 patientsundergoing surgery. According to the goals andobjectives of the study, other patients were dividedinto two groups: the main group – 103 patients withsecondary pancreatic infection, who used the tactic oftreatment «step-up approach»; а comparison group –92 patients with open surgical intervention.Results. In the comparison group were usedopen necrosectomy and drainage. Postoperativecomplications have arisen in 52 (56,2%) patients. Aftersurgery died 26 patients (28,3%), 19 had a 30-daymortality and 7 had a 90-daymortalityof them.In the main group 62 (60,2%) patients were treatedby percutaneous controlled ultrasound intervention,26 (25,2%) by videolaparoscopic necrosectomy anddrainage and at 5 (4,9%) drainage through the wallof the stomach or duodenum. In 10 (9,7%) openoperations were performed (minilumbotomy, uppermedial, left or right-winged minilaparotomy with formation of mini-bursostomy) with pancreaticnecrosectomy, including at 5 decompressiveVAC-laparostomy local access. Postoperativecomplications have arisen in 33 (32%) patients.After surgery died 15 patients (14,6%), 6 had a30-day mortality and 9 had a 90-day mortalityof them. When comparing the two strategies ofthe treatment-tactical approach, the number ofpostoperative complications and mortality were lowerthan in the group of patients who performed only opensurgical interventions (x2 = 6,976, p = 0,011).Conclusion. The our research showed that anindividualized approach to patients with secondarypancreatic infection using the step-up approachprovides a reduction in the number of laparotomicpancreatic necrosectomies and allows postponing«open» surgical interventions for a period after the4th week from the onset of the disease and reducingthe number of postoperative complications andmortality (x2 = 6,976, р = 0,031).Keywords: acute pancreatitis, secondarypancreatic infection, diagnostics, tactics «step-upapproach», surgical treatment.