Factores determinantes de evolución en pacientes operados por complicaciones locales de la pancreatitis aguda

Antecedentes: La necrosis pancreatica infectada y el seudoquiste son complicaciones que en general requieren algun tipo de tratamiento quirurgico (laparoscopico, percutaneo o convencional). Objetivo: Identificar los factores determinantes de mortalidad en pacientes sometidos a cirugia por complicaciones locales de la pancreatitis aguda. Metodo: Se realizo una busqueda bibliografica en la National Library of Medicine mediante Pubmed limitada a los trabajos publicados en ingles, a partir de 1990 utilizando los siguientes terminos solos o en combinacion: "pancreatic necrosis", "necrosectomy", "mortality", "morbidity","local complications", "surgery"y "severe acute pancreatitis". En la base de datos LILACS se realizo tambien una busqueda de los trabajos publicados en Argentina, en el periodo 2000 a 2011. Resultados: Se seleccionaron 119 trabajos y se excluyeron 82 por inadecuado analisis estadistico o insuficiente numero de pacientes. Del analisis de los 37 trabajos seleccionados se identificaron 6 factores determinantes de mortalidad luego de la necrosectomia pancreatica. Estos factores fueron: el intervalo de tiempo entre el ingreso y la necrosectomia, la composicion liquida o solida predominante, la presencia de infeccion, la extension y localizacion de la necrosis pancreatica, la presencia de disfunciones organicas y la organizacion de la necrosis. En la busqueda de la base de datos LILACS se identificaron 7 trabajos publicados sobre cirugia de las complicaciones locales de la pancreatitis aguda. Conclusion: La bibliografia puede identificar seis factores determinantes de evolucion en los pacientes sometidos a cirugias por complicaciones locales de la pancreatitis, lo cual tiene utilidad para el tratamiento.(AU) Background: Infected pancreatic necrosis and pseudocyst are complications that, generally, require any type of surgical treatment (laparoscopic, percutaneous or open surgery). Objective: To identify mortality factors in patients who underwent surgery for local complications of acute pancreatitis. Method: It was conducted a literature search in the National Library of Medicine through Pubmed, limited to publications in English since 1990, using the following keywords: pancreatic necrosis, necrosectomy, mortality, morbidity local complications, surgery and severe acute pancreatitis. In the data base LILACS a similar search was conducted, limited to the Argentine literature, during the period 2000 - 2011. Results: 119 publications were selected and 82 were excluded because of inadequate statistical analysis or insufficient number of patients. After the analysis, 37 publications were selected and 6 mortality factors after pancreatic necrosectomy were identified. These factors were: time between admission and necrosectomy; predominance of liquid orsolid components; presence of infection; extension and localization of pancreatic necrosis; presence of organ failure and walled off necrosis. In the search conducted in the LILACS data base, 7 publications about surgery of the local complications of acute pancreatitis were identified. Conclusion: After the literature search, six factors were identified related to the patient evolution after surgery for pancreatic local complications.(AU)