Conservative surgical treatment of acute pancreatitis

The influence of early management on morbidity in 133 patients with severe acute pancreatitis has been reviewed. Patients with severe pancreatitis (33% mortality rate) were separated from those with mild pancreatitis (0.9% mortality rate) by early objective prognostic signs. Early management (days 0–7) included intra‐abdominal operation in 31 patients and there were 20 deaths (65%). No early intraabdominal surgery was undertaken in 102 patients and there were 18 deaths (18%). Early intra‐abdominal surgery was limited to placement of catheters for peritoneal lavage in 10 patients, and nonoperative management included peritoneal lavage by catheters placed percutaneously in 23 patients. In these 33 patients, there was 1 early death (days 0–10). In contrast, 43% of deaths in nonlavaged patients occurred during this period primarily from cardiovascular or respiratory causes. Overall mortality was slightly reduced in some groups of lavaged patients but the improvement was disappointing. Early intra‐abdominal surgery may be required for diagnosis but it is associated with an increased mortality rate. Peritoneal lavage is an effective adjunct to the management of early complications of severe pancreatitis, but does not prevent the late sequelae of peripancreatic necrosis.