Abstract

Background /Aim: Acute pancreatitis (AP) is a complex disease with various etiology, most frequent biliary and alcoholic. Clinical presentation shows different degree of severity with biphasic evolution. The aim of this study is to evaluate the surgical procedures with mini-invasive approach as preferred choice in patients with pancreatitis.
Methods: Biliary lithiasis and excessive alcohol consumption are the most frequent causes, reaching as a whole the total incidence of 80%. Moreover numerous other causes of pancreatitis are recognized, which on the whole represent 20% of the total. In our Institution from 2000 to 2017 we have observed and treated 351 pancreatitis: 339 acute biliary pancreatitis and 12 chronic alcoholic pancreatitis. Mean age was 49 years (Range: 30-86 yrs). Male female ratio was 1:1, 33. Biliary etiology was confirmed in 339 pts, including 22 pts with recurrent unexplained pancreatitis at initial etiological assessment. The clinical morphological assessment of 339 acute biliary pancreatitis was the following: mild 182, moderate-severe 78, severe 61, early severe 18. We employed a biphasic therapeutic program to control and treat general complications in the first phase. In biliary pathogenesis endoscopic retrograde cholangiopancreatography/ endoscopic sphincterotomy ( ERCP-ES) to assure papillary patency after cholestasis verification. In the second phase control and treatment of pancreatic gatherings and belated acute postnecrotic pseudocysts.
Results: In biliary pancreatitis, the therapeutic program includes assuring papillary patency and CBD cleaning with ERCP/ES. After ERCP, it is necessary to perform laparoscopic cholecystectomy (LC) to complete gallstones treatment. The timing of LC is connected with AP evolution because it is preferable to wait for the stabilization of the general conditions. Treatment of the later phase of AP consists in control and treatment of local complications: infections, haemorrhage, pancreatic and peripancreatic fluid necrotic collections.
Conclusions: In summary in AP it should be preferred the mini-invasive approach for various clinical manifestations.