[FASCIOTOMY IN THE COMPLEX TREATMENT OF THE ABDOMINAL COMPARTMENT SYNDROME FOR PANCREATIC NECROSIS].

The long-term history of studying of a problem of acute pancreatitis in its different aspects, is fight against a pancreatic necrosis and a pancreatic infection. Technology progress in improvement of diagnostic methods and treatment of a pancreatic necrosis and its complications, changed a situation, but treatment of such patients remains the most difficult task for the doctors dealing with pancreatitis issues. The main factor of risk at a pancreatic necrosis are: gland necrosis volume, the severity of enzymatic endo intoxication, degree of intraabdominal hypertension, a translocation of microbes from intestines in the blood circulation and an abdominal cavity. The Abdominal Compartment Syndrome (ACS), at a pancreatic necrosis is connected with presence of multiorgan insufficiency, caused by intraabdominal hypertension. Definition of indications of a fasciotomy in the complex treatment of the adominal compartment for pancreatic necrosis was our research objective. Management of intraabdominal hypertension and ACS consists of a maintenance therapy and if necessary, an abdominal decompression which is considered one of treatment methods. The difficulty of a decompression of an abdominal cavity at ACS which arose on the background of a pancreatic necrosis is that laparotomy in the first phase of its treatment is extremely undesirable and even harmful manipulation which is related to infecting necrotic zones that considerably aggravates the prognosis. These requirements are met by a fasciotomy i.e. broad section of an aponeurosis on the white line of a stomach. The volume of an abdominal cavity at this manipulation increases at the expense of a diastasis of rectus muscle and stretching of skin and peritoneum, while the abdominal cavity hermetism is maintained. We have performed subcutaneous fasciotomy in 4 patients for ACS treatment. The fasciotomy is a targeted mini invasive method for the complex treatment of pancreatic necrosis. Performing fasciotomy and use of a modern complex of an intensive care will allow to achieve improvement of results in the treatment of patients with pancreatic necrosis, without performance of traumatic laparotomy and a laparastomy.