Severe Acute Pancreatitis: the Modern Possibilities of Nonoperative Treatment

There are given modern views on the role of conservative treatment of severe acute pancreatitis and its possibilities. There are considered the most significant aspects of infusion therapy, the use of secretion inhibitors and proteolysis, the choice of antibiotics and antifungal agents, detoxication techniques, and nutrition regimens.Many problems of nonoperative treatment are shown to have no unique solutions. The significance of adequate rehydration is specified. There are presented the advantages and disadvantages of plasmapheresis, hemosorption, thoracic duct flow drainage, venous hemofiltration, indirect electrochemical blood oxidation, ozone therapy, and hyperbaric oxygenation. Limited capacities of using octreotide and antiprotease agents in relation to evidentiary medicine are described. No reliable effect of antibiotic therapy and fungicides on complication rate and mortality in acute pancreatitis is emphasized. The results of nonoperative treatment are demonstrated to depend on the time of initiation of treatment, the adequacy of treatment volume, indications and contraindications, interaction of specialists.