The role of surgery in severe acute pancreatitis. Indications and timing from a prospective study

Background. From January 1991 to December 1995 in the General Surgery Unit of the University of Modena, 119 consecutive patients with acute pancreatitis have been included in a prospective study; postoperative pancreatitis has been excluded. Methods. The severity of the disease has been evaluated by means of Ranson's and Imrie's scores, by contrast enhanced computed tomography and by a computer-assisted method elaborated on the bases of a retrospective series which considers 11 parameters taken into account no later than 8-12 hours from hospitalization. Results. The computer-assisted classification failed only in 8 cases (6.7%) with an attitudinal understaging in comparison with the pathological pictures. The computer-assisted method may be actually considered reliable for the assessment of therapeutical policy Conclusions. In severe acute pancreatitis with extensive necrosis and early lethal outcome despite intensive care, surgical treatment (long active drainage according to Levy) in the acute phase, represents the only hope to reduce early mortality rate. In severe acute pancreatitis with a milder clinical pattern, in the early stage of the disease, 30-40% shows late infectious contamination of necrotic collections. In these cases the computer-assisted method has been particularly useful in picking up, in an early phase, the cases with septic complications with a formal indication to surgery in order to avoid a condition of septic shock. This policy has reduced the mortality rate of acute pancreatitis to 19.4%.