%0 Journal Article
%T The Role of Open Necrosectomy in the Current Management of Acute Necrotizing Pancreatitis: A Review Article
%A K. Vasiliadis
%A C. Papavasiliou
%A A. Al Nimer
%A N. Lamprou
%A C. Makridis
%J ISRN Surgery
%D 2013
%R 10.1155/2013/579435
%X The optimal management of necrotizing pancreatitis continues to evolve. Currently, conservative intensive care treatment represents the primary therapy of acute severe necrotizing pancreatitis, aiming at prevention of organ failure. Following this mode of treatment most patients with sterile necroses can be managed successfully. Surgery might be considered as an option in the late phase of the disease for patients with proven infected pancreatic necroses and organ failure. For these patients surgical debridement is still considered the treatment of choice. However, even for this subgroup of patients, the concept of operative strategy has been recently challenged. Nowadays, it is generally accepted that necrotizing pancreatitis with proven infected necroses as well as septic complications directly caused by pancreatic infection are strong indications for surgical management. However, the question of the most appropriate surgical technique for the treatment of pancreatic necroses remains unsettled. At the same time, recent advances in radiological imaging, new developments in interventional radiology, and other minimal access interventions have revolutionised the management of necrotizing pancreatitis. In light of these controversies, the present paper will focus on the current role of surgery in terms of open necrosectomy in the management of severe acute necrotizing pancreatitis. 1. Introduction Despite the considerable progress in the knowledge of the natural course and pathophysiology of acute pancreatitis (AP), the underlying pathogenetic mechanisms acting during the course of the disease, leading to acinus cell necroses and propagation of necrotizing inflammation, are still to a large extent undefined [1¨C4]. In the majority of cases, AP comprises clinically a mild transitory form of oedematous-interstitial inflammation, which is self-limiting and resolves spontaneously. However, 15%¨C20% of patients with AP will develop the more severe form of the disease [5]. Such patients will initially exhibit a hypovolemic state or even shock, followed by fluid sequestration into the pancreas, peripancreatic areas, and intra- and extraperitoneal spaces [6]. The subsequent systemic hyperinflammation may lead to organ dysfunction and/or local complications, such as pancreatic necrosis (PN) and formation of intra-abdominal abscesses and/or pseudocysts [7, 8]. Primary therapy of severe necrotizing pancreatitis (SNP) consists of a conservative intensive care treatment, aiming at fluid replacement, sufficient analgesia, and prevention of organ failure. Clinical
%U http://www.hindawi.com/journals/isrn.surgery/2013/579435/