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ISRN Surgery
Volume 2013 (2013), Article ID 579435, 10 pages
http://dx.doi.org/10.1155/2013/579435
Review Article

The Role of Open Necrosectomy in the Current Management of Acute Necrotizing Pancreatitis: A Review Article

First Department of General Surgery, Papageorgiou Hospital, Nea Efkarpia, 564 03 Thessaloniki, Greece

Received 20 December 2012; Accepted 7 January 2013

Academic Editors: A. H. Al-Salem, D. W. Blackhurst, D. Laub, and D. E. Ziogas

Copyright © 2013 K. Vasiliadis et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

The optimal management of necrotizing pancreatitis continues to evolve. Currently, conservative intensive care treatment represents the primary therapy of acute severe necrotizing pancreatitis, aiming at prevention of organ failure. Following this mode of treatment most patients with sterile necroses can be managed successfully. Surgery might be considered as an option in the late phase of the disease for patients with proven infected pancreatic necroses and organ failure. For these patients surgical debridement is still considered the treatment of choice. However, even for this subgroup of patients, the concept of operative strategy has been recently challenged. Nowadays, it is generally accepted that necrotizing pancreatitis with proven infected necroses as well as septic complications directly caused by pancreatic infection are strong indications for surgical management. However, the question of the most appropriate surgical technique for the treatment of pancreatic necroses remains unsettled. At the same time, recent advances in radiological imaging, new developments in interventional radiology, and other minimal access interventions have revolutionised the management of necrotizing pancreatitis. In light of these controversies, the present paper will focus on the current role of surgery in terms of open necrosectomy in the management of severe acute necrotizing pancreatitis.