Early definitive surgery in the management of severe acute pancreatitis

OBJECTIVE: To assess the role of early peritoneal lavage and drainage in the management of severeacute pancreatitis.DATA SOURCES: Early peritoneal lavage and drainage was defined as that lavage and drainage shouldbe done in the peritoneal cavity without interference of the pancreas within 72 hours after onset of acutepancreatitis. Biomedical literature database (Medline) from 1981 through 2003 was retrieved and papersabout this treatment were analyzed.RESULTS: Nine papers retrieved included 179 patients with severe acute pancreatitis. In 108 patientsundergoing closed peritoneal lavage and drainage, 7 died, in 15 patients having laparoscopic procedure, 1died, and in 56 patients having open procedure 2 died. The total survival rate was 94.4%.CONCLUSIONS: Even if extensive pancreatic necrosis occurs, early peritoneal lavage and drainage isfeasible to keep the inflammatory pancreas intact and drain peri-pancreatic region in an attempt to improvethe survival rate.