The role of surgery in severe acute pancreatitis

Summary BACKGROUND: Severe acute pancreatitis (SAP) is still related to high mortality rates. Over the past decades, management of SAP changed from an early operative treatment to a more conservative approach. METHODS: Published literature on severe acute pancreatitis and own results were reviewed. RESULTS: Surgical debridement is the gold standard in patients with infected pancreatic necrosis. However surgical intervention for sterile necrosis is only indicated in selected patients if aggressive intensive care is unsuccessful. Patients suspected to have infected pancreatic necrosis, should undergo CT-guided or ultrasound-guided fine-needle aspiration for verification. CONCLUSIONS: By delaying surgery up to the third week, sufficient debridement can be achieved by a single operation, resulting in low mortality and morbidity rates.