Year 2015 Vol. 23 No 6

EXCHANGE OF EXPERIENCE

A.M. TYSHCHENKO1, E.V. MUSHENKO1, R.M. SMACHYLO2

CHANGES IN TREATMENT TACTICS OF ACUTE PANCREATITIS ACCORDING TO REVISED ATLANTA CLASSIFICATION - 2012

SE "V.T. Zaytsev Institute of General and Urgent Surgery of National AMS of Ukraine" 1, Kharkov
Kharkov National Medical University2
Ukraine

Objectives. To study the results of surgical treatment of patients with acute pancreatitis according to suggested tactical approach taking into consideration the revised Atlanta Classification 2012.
Methods. During the period of 2005-2013 yrs. the (n=121) patients with destructive pancreatitis had underwent surgical treatment in GI "V.T. Zaytsev Institute of General and Urgent Surgery of National AMS of Ukraine"; they were subjected to surgical interventions different by volume. Standard laboratory methods as well as ultrasound examination and computed tomography were used for preoperative examination. 269 operations were performed on 121 patients; minimally invasive interventions or their combinations were used in 87,0% cases.
Results. Intraoperative complications developed in 2,6% of patients and they were revealed and treated during the operation. Early postoperative complications developed in 43,8% of patients; the most frequent of them were: postoperative wounds suppuration in 43 patients, intestinal and pancreatic fistulas in 4 and 5 cases, respectively, arrosive bleeding and multiple organ failure in 6 and 9 cases, respectively.
Mortality rate made up 21,5%. The most often causes of death were: intoxication 38,5%, multiple organ failure 23,1%, fulminant pancreatitis 15,4%, arrosive bleeding 11,5%.
Late postoperative complications developed in 23,6% of survivors. Among them: ventral hernias were detected in 10 patients, mechanical jaundice in 2 cases, forming of pancreatic pseudocysts in 2 cases, duodenal obstruction in 2 patients, abscess of spleen in 2 cases.
Conclusion. Staged surgical approach using minimally invasive technologies in treatment of patients with necrotizing pancreatitis permits to decrease the number of intra- and postoperative complication as well as mortality rate in this group of patients.

Keywords: revised Atlanta Classification of acute pancreatitis, acute pancreatitis, necrotizing pancreatitis, surgical treatment, necrosectomy, complication, mortality rate
p. 693-701 of the original issue
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Address for correspondence:
61103, Ukraine,
Harkov, v'ezd Balakireva, d. 1,
GU "Institut obschey i neotlozhnoy khirurgii im. V.T. Zaytseva NAMN Ukrainyi",
tel. office: 38-057-349-41-50,
e-mail: dr_mushenko@mail.ru,
Mushenko Evgeniy Vladimirovich
Information about the authors:
Tyshchenko A.M. MD, professor, a head of the department of hepatic surgery and biliary ducts of SE "V.T Zaytsev Institute of General and Urgent Surgery of National AMS of Ukraine".
Mushenko E.V. PhD, a researcher of the department of diseases of the esophagus and digestive tract of SE" V.T. Zaytsev Institute of General and Urgent Surgery of National AMS of Ukraine".
Smachylo R.M. PhD, an associate professor of the surgery chair 1 of Kharkov National Medical University
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