Surgical tactics in patients with pancreatic necrosis and its complications

Aim. Improving the results of surgical treatment of patients with pancreatic necrosis and its complications based on developing optimal variants of surgical interventions for each case. Methods. The article presents experience of surgical treatment of 344 patients with pancreatic necrosis admitted to surgical clinic №1 of Kazan state medical university in Republican clinical hospital (Kazan) during the period from 2009 to 2015. According to the developed procedure of choosing the optimal treatment options for patients with pancreatic necrosis, depending on the stage, degree of involvement of pancreas and retroperitoneal space and the presence of complications, patients underwent a variety of options and combinations of types of surgical interventions. Under the guidance of X-ray 124 surgeries were performed, in 69 (20.1%) cases surgical interventions under ultrasound (US) guidance were completed with open surgical intervention. Results. Videolaparoscopic interventions with therapeutic and diagnostic purposes were performed in 198 patients with lethal outcomes in 3 (3.1%) cases. As a completed intervention videolaparoscopy was performed in 49 (24.7%) cases. 226 (65.7%) patients underwent open surgery. Most patients required combined surgical treatment, which included a combination of minimally invasive procedures and open surgery in 199 (57.9%) patients. Conclusion. Use of combined methods of surgical treatment in patients with infected pancreatic necrosis greatly improves treatment outcomes; a combination of minimally invasive and open surgery can significantly reduce postoperative mortality in pancreatic necrosis from 17.8% to 12.5%.