Diagnosis and surgical management of acute biliary pancreatitis

Abstract

Introduction: Acute pancreatitis is one of the most common diseases of the abdominal cavity. Improving the treatment policy has reduced mortality, but not enough to consider the problem solved. Aim: Optimization of diagnostic and surgical treatment of acute biliary pancreatitis (ABP). Materials and methods: The results of diagnosis and treatment of 226 patients with acute pancreatitis (AP), of whom 118 (52.5%) had ABP. Women were 86 (72.5%), men - 32 (27.5%). History of gallstone disease (GSD) - from 2 to 9 years. Patients are often treated in hospitals with temporary success. Patients applied the methods of investigation: clinical, laboratory, ultrasound (ultrasonography), endoscopic retrograde cholangiopancreatography (ERCP), fibrogastroduodenoscopy (FGDS), laparoscopy. The I group (main) consist of82 (60.6%) patients with ABP who underwent endoscopic papillosphincterotomy (EPST), the II group (control) - 36 (30.4%) - after the traditional methods of treatment. The 20 patients out of the 36 patients in group II had interstitial pancreatitis, 16 - destructive. Results: The following operations were performed for the first group of patients: resection of the tail of the pancreas - 14, cholecystectomy (CE), holedohostomiya from Wisniewski - 16, holedohoduodenostomiya - 6. The various postoperative complications had 11 (32.3%) patients, mortality was 11.7%. Long-term results in terms of 2 to 8 years were studied in 30 men. Good noted in 62.7%, satisfactory - in 26.5% and unsatisfactory - in 10.8%. Postoperative complications in patients of group II was in 4 (5.4%) patients had no deaths. Long-term results were studied in 63 (76.8%) patients: the good - in 73.5% and satisfactory - in 26.5%. Conclusions: Thus, in the treatment of ABP is expedient to eliminate bile and pancreatic hypertension. The intervention should be individualized, depending of the pathological changes in the pancreas.