The role of non-operative strategies in the management of severe acute pancreatitis.
BACKGROUND
Non-operative strategies are gaining preference in the management of patients with severe acute pancreatitis.


OBJECTIVE
The present study was undertaken to evaluate the efficacy of a non-operative approach, including percutaneous drainage, in the management of severe acute pancreatitis.


METHODS
Prospective study.


METHODS
Tertiary care centre in India.


METHODS
Fifty consecutive patients with severe acute pancreatitis were managed in an intensive care unit.


METHODS
The patients were initially managed conservatively. Those with 5 cm, or more, of fluid collection having fever, leukocytosis or organ failure underwent percutaneous catheter drainage using a 10 Fr catheter. Those not responding underwent a necrosectomy. Depending on the outcome of their supportive care, the patients were divided into three groups: those responding to intensive care, those needing percutaneous catheter drainage and those requiring surgical intervention. Twelve patients were managed conservatively (Group 1) while 24 underwent percutaneous catheter drainage (Group 2), 9 of whom were not operated (Group 2a) and 15 of whom underwent necrosectomy (Group 2b). Fourteen patients were operated on directly (Group 3).


METHODS
Hospital stay, intensive care unit stay, and mortality.


RESULTS
Among patients requiring surgery, the patients in Group 2b had a shorter intensive care unit stay (22.1±11.1 days) as compared to the patients in Group 3 (25.0±15.6 days) and a longer interval to surgery, 30.7±8.9 days versus 25.4±8.5 days. However, these differences did not reach statistical significance (P=0.705 and P=0.133, respectively). The two groups did not differ in terms of mortality (5/15 versus 3/14; P=0.682).


CONCLUSIONS
The use of percutaneous catheter drainage helped avoid or delay surgery in two-fifths of the patients with severe acute pancreatitis.
Department of General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India. jdwsjni@hotmail.com
Jai Dev
JD
Wig
Vikas
V
Gupta
Rakesh
R
Kochhar
Rudra Prasad
RP
Doley
Thakur Deen
TD
Yadav
Kuchhangi S
KS
Poornachandra
Kishore Gurumoorthy Subramanya
KG
Bharathy
Naveen
N
Kalra
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000465:Algorithms; D057785:Catheters; D003422:Critical Care / Q000379:methods*; D004322:Drainage / Q000379:methods; D005260:Female; D006801:Humans; D007194:India; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*; D012720:Severity of Illness Index; D055815:Young Adult