Chirurgische Therapie bei akuter Pankreatitis: Indikation und Technik

About 80–85% of all episodes of acute pancreatitis are mild and self-limiting. In up to 20% of cases, however, severe necrotizing pancreatitis complicated by multiple system organ failure develops. The treatment of such patients has evolved considerably during the past three decades. Clearly, worldwide there is a trend toward being more restrictive with the indication for surgery. The gold standard is conservative treatment in the intensive care unit, nowadays including intravenous antibiotics. In contrast, surgery is mandatory in patients with infected pancreatic necrosis. Today, the best documented approach is an organ-preserving treatment which combines necrosectomy with a postoperative management of evacuation of retroperitoneal necrosis and exudate. Three comparable techniques are available: necrosectomy may be combined with either open packing or planned staged relaparotomy or closed lesser sac and retroperitoneal lavage. With such an approach and the improved management in the intensive care unit, mortality rates in patients with necrotizing pancreatitis dropped to below 15%.

[1]  P. Malfertheiner,et al.  A randomised, double blind, multicentre trial of octreotide in moderate to severe acute pancreatitis , 1999, Gut.

[2]  C. Bassi,et al.  Controlled clinical trial of pefloxacin versus imipenem in severe acute pancreatitis. , 1998, Gastroenterology.

[3]  H. Reber,et al.  Effects of Cytokines and Other Inflammatory Mediators on Human Acute Pancreatitis , 1998 .

[4]  Faizi A. Siddiqi,et al.  Role of antibiotics in acute pancreatitis: A meta-analysis , 1998, Journal of Gastrointestinal Surgery.

[5]  J. Galloway,et al.  Pancreatic necrosis: results of necrosectomy, packing, and ultimate closure over drains. , 1998, Annals of surgery.

[6]  S. Kriwanek,et al.  Early versus late necrosectomy in severe necrotizing pancreatitis. , 1998, American journal of surgery.

[7]  J. Söreide,et al.  Management of necrotizing pancreatitis by repeated operative necrosectomy using a zipper technique. , 1998, American journal of surgery.

[8]  B. Rau,et al.  Role of ultrasonographically guided fine‐needle aspiration cytology in the diagnosis of infected pancreatic necrosis , 1998, The British journal of surgery.

[9]  J. Norman.  The role of cytokines in the pathogenesis of acute pancreatitis. , 1998, American journal of surgery.

[10]  G. Zibari,et al.  Nonoperative therapy for acute necrotizing pancreatitis. , 1997, The American surgeon.

[11]  G. Steinbach,et al.  The potential role of procalcitonin and interleukin 8 in the prediction of infected necrosis in acute pancreatitis , 1997, Gut.

[12]  M. Büchler,et al.  [Surgical therapy of severe acute pancreatitis]. , 1997, Schweizerische medizinische Wochenschrift.

[13]  R. Lüdtke,et al.  Early ERCP and papillotomy compared with conservative treatment for acute biliary pancreatitis. The German Study Group on Acute Biliary Pancreatitis. , 1997, The New England journal of medicine.

[14]  M. Büchler,et al.  Laparoscopic Cholecystectomy in Acute Biliary Pancreatitis , 1996 .

[15]  G. Manes,et al.  Nonsurgical Treatment of Acute Necrotizing Pancreatitis , 1996, Pancreas.

[16]  W. Uhl,et al.  TECHNIK UND ERGEBNISSE DER CHIRURGISCHEN THERAPIE BEI AKUTER PANKREATITIS , 1996 .

[17]  V. Valtonen,et al.  Early antibiotic treatment in acute necrotising pancreatitis , 1995, The Lancet.

[18]  W. Uhl,et al.  Management of sterile necrosis in instances of severe acute pancreatitis. , 1995, Journal of the American College of Surgeons.

[19]  J. Lange,et al.  Controlled Clinical Trial of Selective Decontamination for the Treatment of Severe Acute Pancreatitis , 1995, Annals of surgery.

[20]  B. Rau,et al.  Necrosectomy and postoperative local lavage in necrotizing pancreatitis. , 1995, Annali italiani di chirurgia.

[21]  M. Büchler,et al.  Acute pancreatitis: necrosectomy and closed continuous lavage of the retroperitoneum , 1994 .

[22]  J. Karjalainen,et al.  Changing strategies in the surgical management of acute necrotizing pancreatitis. , 1994, International surgery.

[23]  C. Bassi,et al.  A randomized multicenter clinical trial of antibiotic prophylaxis of septic complications in acute necrotizing pancreatitis with imipenem. , 1993, Surgery, gynecology & obstetrics.

[24]  P. Malfertheiner,et al.  Pancreatic Necrosis: An Early Finding in Severe Acute Pancreatitis , 1993, Pancreas.

[25]  P. Malfertheiner,et al.  Gabexate mesilate in human acute pancreatitis , 1993 .

[26]  C. Lo,et al.  Early treatment of acute biliary pancreatitis by endoscopic papillotomy. , 1993, The New England journal of medicine.

[27]  P. Malfertheiner,et al.  Gabexate mesilate in human acute pancreatitis. German Pancreatitis Study Group. , 1993, Gastroenterology.

[28]  P. Malfertheiner,et al.  Human pancreatic tissue concentration of bactericidal antibiotics. , 1992, Gastroenterology.

[29]  D. Rattner,et al.  Early surgical débridement of symptomatic pancreatic necrosis is beneficial irrespective of infection. , 1992, American journal of surgery.

[30]  W. Uhl,et al.  Acute pancreatitis: when and how to operate. , 1992, Digestive diseases.

[31]  P. Puolakkainen,et al.  Pancreatic Resection Versus Peritoneal Lavage in Acute Necrotizing Pancreatitis: A Prospective Randomized Trial , 1991, Annals of surgery.

[32]  M. Farnell,et al.  Acute necrotizing pancreatitis: Management by planned, staged pancreatic necrosectomy/debridement and delayed primary wound closure over drains , 1991, The British journal of surgery.

[33]  P. Malfertheiner,et al.  PMN‐Elastase in Comparison with CRP, Antiproteases, and LDH as Indicators of Necrosis in Human Acute Pancreatitis , 1991, Pancreas.

[34]  H. Reber,et al.  Surgical Intervention in Acute Pancreatitis: When and How , 1991, Pancreas.

[35]  K. Allen,et al.  A prospective longitudinal study of observation versus surgical intervention in the management of necrotizing pancreatitis. , 1991, American journal of surgery.

[36]  C. Frey,et al.  Comprehensive management of acute necrotizing pancreatitis and pancreatic abscess. , 1990, Archives of surgery.

[37]  E. Balthazar.  CT diagnosis and staging of acute pancreatitis. , 1989, Radiologic clinics of North America.

[38]  J. Neoptolemos,et al.  CONTROLLED TRIAL OF URGENT ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY AND ENDOSCOPIC SPHINCTEROTOMY VERSUS CONSERVATIVE TREATMENT FOR ACUTE PANCREATITIS DUE TO GALLSTONES , 1988, The Lancet.

[39]  D. Wagner,et al.  Gallstone pancreatitis: a prospective randomized trial of the timing of surgery. , 1988, Surgery.

[40]  J. Isolauri,et al.  Influence of pancreatic resection on systemic complications in acute necrotizing pancreatitis , 1988, The British journal of surgery.

[41]  M. Büchler,et al.  Necrosectomy and postoperative local lavage in necrotizing pancreatitis , 1988, The British journal of surgery.

[42]  P. Banks,et al.  Early diagnosis of pancreatic infection by computed tomography-guided aspiration. , 1987, Gastroenterology.

[43]  E. Bradley.  Management of Infected Pancreatic Necrosis by Open Drainage , 1987, Annals of surgery.

[44]  W. Uhl,et al.  Sensitivity of antiproteases, complement factors and C-reactive protein in detecting pancreatic necrosis. Results of a prospective clinical study , 1986, International journal of pancreatology : official journal of the International Association of Pancreatology.

[45]  M. Büchler,et al.  Bacterial contamination of pancreatic necrosis. A prospective clinical study. , 1986, Gastroenterology.

[46]  H. Bismuth,et al.  Pancreatic debridement in acute necrotizing pancreatitis: An obsolete procedure? , 1986, The British journal of surgery.

[47]  W. Hess.  Gallstone pancreatitis. , 1986, The Italian journal of surgical sciences.

[48]  I. Nordback,et al.  Long‐term results after pancreas resection for acute necrotizing pancreatitis , 1985, The British journal of surgery.

[49]  R. Williamson,et al.  Controlled clinical trial of peritoneal lavage for the treatment of severe acute pancreatitis. , 1985, The New England journal of medicine.

[50]  M. McMahon,et al.  Biochemical identification of patients with gallstones associated with acute pancreatitis on the day of admission to hospital. , 1985, Annals of surgery.

[51]  K. Ohlsson,et al.  Peritoneal lavage in severe acute pancreatitis. , 1984, Acta chirurgica Scandinavica.

[52]  J. Aldrete,et al.  Clinical implications derived from the morphological classification of 89 patients with acute pancreatitis. , 1983, Journal of clinical gastroenterology.

[53]  M. McCarthy,et al.  Surgical management of severe acute pancreatitis. , 1982, Archives of surgery.

[54]  Jerome J. Schentag,et al.  Principles of antibiotic tissue penetration and guidelines for pharmacokinetic analysis. , 1982, The Medical clinics of North America.

[55]  E. Kivilaakso,et al.  Resection of the pancreas for acute fulminant pancreatitis. , 1981, Surgery, gynecology & obstetrics.

[56]  A. Warshaw.  A guide to pancreatitis. , 1980, Comprehensive therapy.

[57]  C. Frey.  Hemorrhagic pancreatitis. , 1979, American Journal of Surgery.

[58]  M. Kasdan,et al.  The treatment of acute hemorrhagic pancreatitis by sump drainage. , 1968, Surgery, gynecology & obstetrics.