title: IAP Guidelines for the Surgical Management of Acute Pancreatitis.
abstract: During 2002 the International Association of Pancreatology developed evidenced-based guidelines on the surgical management of acute pancreatitis. There were 11 guidelines, 10 of which were recommendations grade B and one (the second) grade A. (1) Mild acute pancreatitis is not an indication for pancreatic surgery. (2) The use of prophylactic broad-spectrum antibiotics reduces infection rates in computed tomography-proven necrotizing pancreatitis but may not improve survival. (3) Fine-needle aspiration for bacteriology should be performed to differentiate between sterile and infected pancreatic necrosis in patients with sepsis syndrome. (4) Infected pancreatic necrosis in patients with clinical signs and symptoms of sepsis is an indication for intervention including surgery and radiological drainage. (5) Patients with sterile pancreatic necrosis (with negative fine-needle aspiration for bacteriology) should be managed conservatively and only undergo intervention in selected cases. (6) Early surgery within 14 days after onset of the disease is not recommended in patients with necrotizing pancreatitis unless there are specific indications. (7) Surgical and other forms of interventional management should favor an organ-preserving approach, which involves debridement or necrosectomy combined with a postoperative management concept that maximizes postoperative evacuation of retroperitoneal debris and exudate. (8) Cholecystectomy should be performed to avoid recurrence of gallstone-associated acute pancreatitis. (9) In mild gallstone-associated acute pancreatitis, cholecystectomy should be performed as soon as the patient has recovered and ideally during the same hospital admission. (10) In severe gallstone-associated acute pancreatitis, cholecystectomy should be delayed until there is sufficient resolution of the inflammatory response and clinical recovery. (11) Endoscopic sphincterotomy is an alternative to cholecystectomy in those who are not fit to undergo surgery in order to lower the risk of recurrence of gallstone-associated acute pancreatitis. There is however a theoretical risk of introducing infection into sterile pancreatic necrosis. These guidelines should now form the basis for audit studies in order to determine the quality of patient care delivery.
authors.affiliation: Department of General Surgery, University of Heidelberg, Germany.
authors.forename: Waldemar
authors.initials: W
authors.lastname: Uhl
authors.forename: Andrew
authors.initials: A
authors.lastname: Warshaw
authors.forename: Clement
authors.initials: C
authors.lastname: Imrie
authors.forename: Claudio
authors.initials: C
authors.lastname: Bassi
authors.forename: Colin J
authors.initials: CJ
authors.lastname: McKay
authors.forename: Paul G
authors.initials: PG
authors.lastname: Lankisch
authors.forename: Ross
authors.initials: R
authors.lastname: Carter
authors.forename: Eugene
authors.initials: E
authors.lastname: Di Magno
authors.forename: Peter A
authors.initials: PA
authors.lastname: Banks
authors.forename: David C
authors.initials: DC
authors.lastname: Whitcomb
authors.forename: Christos
authors.initials: C
authors.lastname: Dervenis
authors.forename: Charles D
authors.initials: CD
authors.lastname: Ulrich
authors.forename: Kat
authors.initials: K
authors.lastname: Satake
authors.forename: Paula
authors.initials: P
authors.lastname: Ghaneh
authors.forename: Werner
authors.initials: W
authors.lastname: Hartwig
authors.forename: Jens
authors.initials: J
authors.lastname: Werner
authors.forename: Gerry
authors.initials: G
authors.lastname: McEntee
authors.forename: John P
authors.initials: JP
authors.lastname: Neoptolemos
authors.forename: Markus W
authors.initials: MW
authors.lastname: Büchler
mesh_terms: D000208:Acute Disease; D006801:Humans; D010195:Pancreatitis / Q000601:surgery*