Surgical management of acute pancreatitis in Italy: lessons from a prospective multicentre study.
OBJECTIVE
This study aimed to evaluate the surgical treatment of acute pancreatitis in Italy and to assess compliance with international guidelines.


METHODS
A series of 1173 patients in 56 hospitals were prospectively enrolled and their data analysed.


RESULTS
Twenty-nine patients with severe pancreatitis underwent surgical intervention. Necrosectomy was performed in 26 patients, associated with postoperative lavage in 70% of cases. A feeding jejunostomy was added in 37% of cases. Mortality was 21%. Of the patients with mild pancreatitis, 714 patients with a biliary aetiology were evaluated. Prophylactic treatment of relapses was carried out in 212 patients (36%) by cholecystectomy and in 161 using a laparoscopic approach. Preoperative endoscopic retrograde cholangiopancreatography was associated with cholecystectomy in 83 patients (39%). Forty-seven patients (22%) were treated at a second admission, with a median delay of 31 days from the onset of pancreatitis. Eighteen patients with severe pancreatitis underwent cholecystectomy 37.9 days after the first admission. There were no deaths.


CONCLUSIONS
The results indicate poor compliance with published guidelines. In severe pancreatitis, early surgical intervention is frequently performed and enteral feeding is seldom used. Only a small number of patients with mild biliary pancreatitis undergo definitive treatment (i.e. cholecystectomy) within 4 weeks of the onset of pancreatitis.
Department of Surgery and Emergency Surgery, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS [Institute for Scientific Care and Treatment]) Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy. pderai@policlinico.mi.it
Paolo
P
De Rai
Alessandro
A
Zerbi
Laura
L
Castoldi
Claudio
C
Bassi
Luca
L
Frulloni
Generoso
G
Uomo
Armando
A
Gabbrielli
Raffaele
R
Pezzilli
Giorgio
G
Cavallini
Valerio
V
Di Carlo
D000368:Aged; D001660:Biliary Tract Diseases / Q000150:complications / Q000401:mortality / Q000601:surgery*; D016009:Chi-Square Distribution; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002763:Cholecystectomy / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D017081:Cholecystectomy, Laparoscopic; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007558:Italy; D007582:Jejunostomy / Q000009:adverse effects / Q000401:mortality; D008297:Male; D010180:Pancreatectomy / Q000009:adverse effects / Q000401:mortality; D010195:Pancreatitis / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D019283:Pancreatitis, Acute Necrotizing / Q000209:etiology / Q000601:surgery; D019512:Pancreatitis, Alcoholic / Q000209:etiology / Q000601:surgery; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome