Surgical treatment of necrotizing pancreatitis and complicated forms of cholecystopancreatitis

The authors present a retrospective clinical analysis of 25 operated patients with necrotizing pancreatitis and severe cholecystopancreatitis. The severity of the disease was evaluated by the Ranson scale. Diagnosis was made using all available contemporary diagnostic methods. Eleven of the patients were operated in the first 2-5 days after admission because of severe form of acute pancreatitis resisting medical therapy (Ranson > 3) and 8 patients with infected necrotizing pancreatitis underwent surgery within 2-3 weeks after the disease onset. Five of the patients died (26.32%). Only one patient died (16.66%) out of the patients of the second group including patients with acute complicated cholecystopancreatitis (n = 6). The authors think that treatment of acute pancreatitis at its onset should be mainly conservative. Laparotomy should be resorted to only in cases of uncertain diagnosis. Surgery or percutaneous drainage should be used in infected necrotizing pancreatitis and the most favorable term of operation is 2-3 weeks after the disease onset. Severe pancreatitis associated with gallstone disease and its complications require emergency surgery.