RESUMEN
AIMS: In this retrospective trial we assess how acute pancreatitis patients respond to nonoperative therapy; operative methods and results after surgery for acute and chronic-recurrent pancreatitis. METHODS: We present 738 acute pancreatitis patients, treated from 1991 to 2001 in our clinic. In all cases we start a nonoperative therapy comprising losses replacement, analgesics (including narcotic ones), spasmolytics, antibiotics, protease inhibitors-Contrical or Gordox (only during 1997 and 1998) and/or somatostatine (Sandostatin), H2-blockers, naso-gastric tube. Monitoring of the main parameters as blood pressure and pulse rate, number of leukocytes, values of serum amylase, urea and creatinine is performed. RESULTS: 576 responded to this therapy and recovered. The ones who worsened--162 acute pancreatitis patients--underwent surgery: necrectomy followed by postoperative prolonged local lavage in the area of pancreatic couch or laparostomy. This method contributes to a prolonged evacuation of biologically active substances and devitalized tissues. The average number of Ranson's Prognostic Criteria was 4.5. Furthermore, mortality is reduced to 19%. A mortality analysis is done. Surgery (cholecystectomy and bile duct exploration) is offered to patients who recovered from acute pancreatitis caused by cholelythiasis and/or choledocholythiasis. CONCLUSIONS: The majority of patients respond to the nonoperative therapy. Despite the recent improvement in diagnostics and treatment of acute pancreatitis morbidity and mortality rates are still high.