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Review
. 2023 Mar 27;15(3):307-322.
doi: 10.4240/wjgs.v15.i3.307.

Surgical management of acute pancreatitis: Historical perspectives, challenges, and current management approaches

Nasser Alzerwi  1
Affiliations
Review

Surgical management of acute pancreatitis: Historical perspectives, challenges, and current management approaches

Nasser Alzerwi. World J Gastrointest Surg. .

Abstract

Acute pancreatitis (AP) is a serious condition presenting catastrophic consequences. In severe AP, the mortality rate is high, and some patients initially diagnosed with mild-to-moderate AP can progress to a life-threatening severe state. Treatment of AP has evolved over the years. Drainage was the first surgical procedure performed for AP; however, later, surgical approaches were replaced by more conservative approaches due to the availability of advanced medical care and improved understanding of the course of AP. Currently, surgery is used to manage several complications of AP, such as pseudocysts, pancreatic fistulas, and biliary tract obstruction. Patients who are unresponsive to conservative treatment or have complications are typically considered for surgical intervention. This review focuses on the surgical approaches (endoscopic, percutaneous, and open) that have been established in recent studies to treat this acute condition and summarizes the common management guidelines for AP, discussing the relevant indications, significance, and complications. It is evident that despite their reduced involvement, surgeons lead the multidisciplinary care of patients with AP; however, given the gaps in existing knowledge, more research is required to standardize surgical protocols for AP.

Keywords: Acute pancreatitis; Endoscopic management; Necrosectomy; Open surgery; Surgery.

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Conflict of interest statement

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

Figures

Figure 1
Figure 1
Etiologies and evolution of surgical management of acute pancreatitis. A: Key acute pancreatitis etiologies; B: Evolution of surgical management.
Figure 2
Figure 2
Local complications in acute pancreatitis. ANC: Acute necrotic collections; PFC: Peripancreatic fluid collections; WON: Walled-off necrosis.
Figure 3
Figure 3
Pathogenesis of acute pancreatitis. Early activation of trypsinogen to trypsin in acinar cells triggers a cascade of pathogenic events, resulting in acute pancreatitis. AP: Acute pancreatitis; NF-kB: Nuclear factor kB.
Figure 4
Figure 4
Flow chart of surgical management of acute pancreatitis. AP: Acute pancreatitis.
Figure 5
Figure 5
Decision-making targets in the surgical management of acute pancreatitis (decision-making map). AP: Acute pancreatitis.
Figure 6
Figure 6
Year-wise growth in the number of publications on the surgical management of acute pancreatitis.
See this image and copyright information in PMC

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