title: Surgical strategies in severe acute pancreatitis (SAP): indications, complications and surgical approaches.
abstract: BACKGROUND
  Severe acute pancreatitis (SAP) is still related to high mortality rates. This study evaluated the various surgical strategies for treatment of suspected infected necroziting pancreatitis (INP).
  
  
  METHODS
  This retrospective study included 212 patients with SAP and INP, who had surgical treatment during the period between January 2000 - December 2012 at the Ist Surgical Clinic. Surgical approaches included laparostomy with continous postoperative retropancreatic lavage, open abdomen strategy, laparotomy with primary abdominal closure accompanied or not by laparostomy (marsupialization), retroperiostomy with retroperitoneal lavage.
  
  
  RESULTS
  The overall mortality rate was 34.0 percent, with 24 percent in laparotomy with continous retropancreatic lavage,11 percent for retroperitoneostomy and retroperitoneal continous lavage, 71 percent for the open abdomen strategy,and 43 percent for laparotomy with closed abdomen(p 0.001). Acute operations, alcoholic origin, Apache II scores of ¥10 organ dysfunction on admission were independent factors that predisposed patients to complications.Colonic necrosis with high mortality rates (53 percent), however seemed to be of prognostic relevance.
  
  
  CONCLUSIONS
  The conservative approach in severe acutepancreatitis is a promising therapeutic concept. Delaying surgery up to the third week after onset of disease significantly improves the patients survival. Complications are common in severe necrotizing pancreatitis leading to organ failure and need for acute operations. Colonic necros is is an independent prognostic factor for survival.
authors.forename: L
authors.initials: L
authors.lastname: Kiss
authors.forename: GhN
authors.initials: G
authors.lastname: Sarbu
authors.forename: A
authors.initials: A
authors.lastname: Bereanu
authors.forename: R
authors.initials: R
authors.lastname: Kiss
mesh_terms: D018806:APACHE; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000379:methods; D019283:Pancreatitis, Acute Necrotizing / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D011379:Prognosis; D012187:Retroperitoneal Space / Q000601:surgery; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016019:Survival Analysis; D007507:Therapeutic Irrigation / Q000379:methods; D016896:Treatment Outcome