Surgery for Acute Pancreatitis

Pancreas is a small organ situated in the upper abdomen behind the stomach that serves dual role. Exocrine part of the pancreas secretes digestive juices that help in digestion of food particularly proteins & fats. While endocrine part secretes many hormones (including insulin) that controls blood sugar levels.

Acute pancreatitis is a condition where pancreas develops sudden onset swelling (inflammation). Patient presents with severe pain in abdomen that typically radiates to the back and may be associated with vomiting, fever and fast heart rate.

Gallstones & alcohol are responsible for acute pancreatitis in over 80-90% of patients.

Acute pancreatitis is classified as: mild or severe pancreatitis depending on the clinical presentation.

Mild pancreatitis: Fortunately, majority of patients present with mild pancreatitis that usually resolves within a week of onset of pain abdomen.

Severe pancreatitis:  Patients present with organ dysfunction and frequently need ICU care & prolonged hospitalization. These patients are best managed at tertiary care centres.

Surgery for gallstones in acute pancreatitis

– Mild acute biliary pancreatitis – Laparoscopic cholecystectomy should ideally be done within same hospitalization prior to discharge from the hospital.

– Severe acute biliary pancreatitis – Depending on patient’s recovery surgical team will decide the timing of laparoscopic cholecystectomy.

Surgery for acute necrotizing pancreatitis

Intervention usually required 3-4 weeks after the onset of pain abdomen

Necrosectomy can be performed by following approaches:

  • Endoscopic
  • Retroperitoneal – Laparoscopic
  • Classical – open

Best approach for an individual patient is decided by multidisciplinary team.

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