Abstract:

Introduction: Severe acute pancreatitis is a disease that is often complicated by a complex pathological process, difficult to manage and associated with high morbidity and mortality. Approximately 80% of patients have a mild form of the disease, while the remaining 20% develop a severe lifethreatening necrotizing complication. These patients are at high risk of infection, multisystem organ failure and death. Necrosis of pancreas, often infected, requires a multimodal step-up approach and often needs a treatment through an invasive procedure. Over the last few decades, great advances have been made in the treatment of patients with acute pancreatitis, and in particular the necrotic form of the disease. However, morbidity and mortality still remain high. Aim: To present our experience in the treatment of necrotic pancreatitis through mini-invasive procedures as a percutaneous drainage, laparoscopic necrectomy, outlining the clear prerequisites and benefits of the recovery process of patients. Method: 32 cases operated on for necrotic pancreatitis were examined for the purpose of the study. The mean age of the patients was 50.7 years (37 to 64 years). The cases were followed by ultrasound and CT scan examinations. Results: The examined data were compared regarding the postoperative stay (17.5 days on average); mortality-two patients; operative approach (one-stage and two-stage) depending on the genesis of pancreatitis, as well as the severity of the patients’ general condition and vital signs. Laparoscopic cholecystectomy - 10 cases, laparoscopic revision of the Common Bile Duct (CBD) with T-tube placement - 18 patients. Subsequent laparoscopic necrosectomy were used in 23 cases. In five cases it was necessary to make a double-barreled small intestinal protective anus. In 7 of the cases, due to the severe general condition of patients, initial drainage of Walled-Off Pancreatic Necrosis (WOPN) was required.All patients show good tolerance to treatment and good response to pain syndrome. All patients received total parenteral nutrition after admission. Early removal of the nasogastric tube and started feeding (4-5 days) in the postoperative period. Outpatient follow-up of cases for 3 months. Conclusion: The mini-invasive approach of this life-threatening disease and resolution of its complications are primary goals in the treatment of necrotic pancreatitis. This should be referred to an interdisciplinary team of gastroenterologist, surgeon, interventional radiologist, specialists in intensive care medicine, infectious disease, and nutritionist. Nowadays, laparoscopic surgical treatment of necrotic pancreatitis is effective alternative to other modalities in the treatment of infected pancreatic necrosis. This method also reduces the postoperative pain and significantly improve quality of life of these patients.