title: Interventional Treatment of Abdominal Compartment Syndrome during Severe Acute Pancreatitis: Current Status and Historical Perspective.
abstract: Abdominal compartment syndrome (ACS) in patients with severe acute pancreatitis (SAP) is a marker of severe disease. It occurs as combination of inflammation of retroperitoneum, visceral edema, ascites, acute peripancreatic fluid collections, paralytic ileus, and aggressive fluid resuscitation. The frequency of ACS in SAP may be rising due to more aggressive fluid resuscitation, a trend towards conservative treatment, and attempts to use a minimally invasive approach. There remains uncertainty about the most appropriate surgical technique for the treatment of ACS in SAP. Some unresolved questions remain including medical treatment, indications, timing, and interventional techniques. This review will focus on interventional treatment of this serious condition. First line therapy is conservative treatment aiming to decrease IAP and to restore organ dysfunction. If nonoperative measures are not effective, early abdominal decompression is mandatory. Midline laparostomy seems to be method of choice. Since it carries significant morbidity we need randomized studies to establish firm advantages over other described techniques. After ACS resolves efforts should be made to achieve early primary fascia closure. Additional data are necessary to resolve uncertainties regarding ideal timing and indication for operative treatment.
authors.affiliation: Clinic for Digestive Surgery, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
authors.forename: Dejan V
authors.initials: DV
authors.lastname: Radenkovic
authors.affiliation: Department of Surgery, University Hospital Southampton, Southampton, UK.
authors.forename: Colin D
authors.initials: CD
authors.lastname: Johnson
authors.affiliation: Institute for Biostatistics and Informatics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
authors.forename: Natasa
authors.initials: N
authors.lastname: Milic
authors.affiliation: Clinic for Emergency Surgery, Emergency Center, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
authors.forename: Pavle
authors.initials: P
authors.lastname: Gregoric
authors.affiliation: Clinic for Emergency Surgery, Emergency Center, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
authors.forename: Nenad
authors.initials: N
authors.lastname: Ivancevic
authors.affiliation: Clinic for Surgery, Military Medical Academy, Belgrade, Serbia.
authors.forename: Mihailo
authors.initials: M
authors.lastname: Bezmarevic
authors.affiliation: Clinic for Surgery, Clinical Center "Bezanijska Kosa", Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
authors.forename: Dragoljub
authors.initials: D
authors.lastname: Bilanovic
authors.affiliation: Clinic for Surgery, Clinical Center "Zvezdara", Belgrade, Serbia.
authors.forename: Vladimir
authors.initials: V
authors.lastname: Cijan
authors.affiliation: Clinic for Digestive Surgery, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
authors.forename: Andrija
authors.initials: A
authors.lastname: Antic
authors.affiliation: Clinic for Digestive Surgery, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
authors.forename: Djordje
authors.initials: D
authors.lastname: Bajec
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