Surgical tactics with acute pancreatitis complicated ascites-peritonitis

Abstract

Fluid accumulation in the peri-pancreatic region and the distal areas of the abdominal cavity is widespread in the early stage of acute severe pancreatitis. The fluid is mainly hemorrhagic ascites, rich in activated lipolytic and proteolytic enzymes, vasoactive substances and inflammatory cytokines, and is aseptic at the onset of the disease. Evacuation of a fluid rich in potentially toxic mediators from the abdominal cavity is supported in a number of publications as a rational measure to alleviate the burden of disease in critically ill patients. The purpose of the study was to analyze recent publications on surgical tactics for enzymatic peritonitis and its impact on acute severe pancreatitis. A thorough analysis of the literature made it possible to draw the following conclusions related to the state of this problem. To date, randomized clinical trials and publications show controversial data on the efficacy of surgical interventions for acute pancreatitis complicated by ascites-peritonitis. International recommendations have a low level of evidence regarding the effectiveness of drainage, lavage and video-laparoscopic rehabilitation due to inclusion of patients with non-severe pancreatitis into individual studies. Optimization of surgical tactics in patients with ascites-peritonitis in severe pancreatitis may be associated with the definition of: the severity of the condition in patient with ascites-peritonitis, parapancreatitis severity, toxicity level of ascites-peritonitis, indications and optimal drainage / lavage time. To address these issues, there is a need for further prospective studies.