[Improvement of surgical strategy for acute biliary pancreatitis].

Abstract

Objective: To improve surgical tactics for acute biliary pancreatitis.

Material and methods: Treatment outcomes were analyzed in 502 patients with acute biliary pancreatitis. Patients were divided into two groups depending on surgical tactics: control group (n=293) - standard diagnosis and treatment of biliary pancreatitis, main group (n=209) - treatment of biliary pancreatitis based on original algorithm. In these patients, therapeutic and diagnostic program included functional state of biliary tract and stratification of patients depending on severity of acute pancreatitis (APACHE II and Imrie/Glasgow scale) in addition to standard procedures.

Results: There are 2 fundamentally different clinical variants of ductal hypertension and biliary pancreatitis: with acute blockade of pancreatobiliary tract (obstructive variant) and without this blockade (non-obstructive variant). Each variant included various clinical forms of acute biliary pancreatitis etiologically associated with specific biliary disease. In the 2^nd group, a differentiated surgical approach was applied taking into account clinical variant of biliary pancreatitis. The first stage implied correction of pancreatobiliary ductal hypertension through minimally invasive methods. At the second stage, radical surgical debridement of biliary tract was performed with elimination of etiological factor of biliary pancreatitis within the same hospitalization in patients with mild-to-moderate disease. In patients with severe biliary pancreatitis, the second stage of treatment was carried out 3 months after discharge. This treatment strategy reduced the number of infectious and inflammatory complications from 26.6% to 11.5%, mortality from 7.5% to 3.3% and avoid recurrent biliary pancreatitis.

Conclusion: Original therapeutic and diagnostic algorithm optimizes surgical strategy and improves the effectiveness of treatment of acute biliary pancreatitis.