The surgical management of severe acute pancreatitis (SAP) has evolved rapidly over the past decade. Pancreatitis is a disease that encompasses a range of physiological disturbances that can be mild and transient, or immediately life-threatening and resulting in prolonged critical illness. Importantly, pancreatitis is a dynamic process and can continue to develop in severity for several weeks or even months after the acute insult.
The optimal approach to the patient with SAP first involves prompt recognition of the disease process, identification of onset and duration, and comprehensive evaluation by a multidisciplinary team. The role of the surgeon on this team is central, even for patients who will not necessarily proceed to the OR, as is collaboration with the procedural gastroenterologist, the expert radiologist, and the intensivist.
We attempt to define SAP through the eyes of the surgeon and explore the surgical indications and surgical management of SAP. The major indication for operative intervention here remains the presence of infected pancreatic necrosis, for which there are several operative approaches to source control. In addition, later complications of SAP constitute indications for surgical interventions, such as pancreatic pseudocyst and pancreatic fistula.
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