Surgical indications in acute pancreatitis.
OBJECTIVE
This review provides an update on the surgical management of acute pancreatitis, with a focus on evidence accumulated over the past year regarding the optimal approach to pancreatic debridement in the critically ill patient.


RESULTS
Infected pancreatic necrosis remains the primary indication for surgery in patients with acute pancreatitis. Up to a quarter of patients with acute pancreatitis develop early bacteremia and pneumonia, and assessment of patients for surgery should include a thorough search for nonpancreatic sources of infection. Retroperitoneal, percutaneous and endoscopic approaches to pancreatic debridement can be used with success in appropriately selected critically ill patients. All minimally invasive approaches to necrosectomy are evolving, and there is currently insufficient evidence to advocate one approach over another. Management of patients with acute pancreatitis at high-volume centers appears to be associated with a survival benefit.


CONCLUSIONS
The existing evidence demonstrates that control of infected pancreatic necrosis without laparotomy is possible with appropriate patient selection. Evidence regarding minimally invasive approaches to pancreatic debridement remains of limited quality.
Haas
Barbara
B
Department of Surgery, St Michael's Hospital, University of Toronto, Toronto, Canada. barbara.haas@utoronto.ca
Nathens
Avery B
AB
D003657:Decision Making; D004724:Endoscopy / Q000379:methods; D006801:Humans; D007813:Laparotomy / Q000379:methods; D010179:Pancreas / Q000473:pathology* / Q000601:surgery; D019283:Pancreatitis, Acute Necrotizing / Q000473:pathology / Q000601:surgery*