[Operative treatment of necrotic pancreatitis].

Treatment of necrotic pancreatitis patients is still disputable, posing serious problems and a real challenge to surgeons. The surgeon's approach to the problem ranges from strictly conservative to extremely aggressive. In this paper are discussed the indications, timing and operative technique used in the treatment of necrotic pancreatitis (NP), with special attention focused on the method suggested by the authors--necrotomy and closed continuous lavage of the retroperitoneum. An algorithm of the therapeutic approach to patients presenting acute pancreatitis is likewise presented. All patients with necrotic pancreatitis are routinely referred for treatment in the intensive care unit (ICU), and mandatorily subjected to antibiotherapy. Only one-third of the cases developing infected pancreatic necrosis (IPN) within 3 weeks of admission undergo operation. Lethality among those operated on is reduced to 13 per cent, and among NP patients--4 per cent. The new concept for therapeutic approach to necrotic pancreatitis patients according to which only cases presenting evidence of infected pancreatic necrosis are liable to surgery, whereas those with SPN should be treated conservatively, is strongly supported.