Alzerwi N. Surgical management of acute pancreatitis: Historical perspectives, challenges, and current management approaches. World J Gastrointest Surg 2023; 15(3): 307-322 [PMID: 37032793 DOI: 10.4240/wjgs.v15.i3.307]
Corresponding Author of This Article
Nasser Alzerwi, MBBS, SBGS, ABGS, FSMC(HPB), Associate Professor, Department of Surgery, Majmaah University, P. O. Box 66, Al-Majmaah City, Riyadh Region, Riyadh 11952, Saudi Arabia. n.alzerwi@mu.edu.sa
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Surg. Mar 27, 2023; 15(3): 307-322 Published online Mar 27, 2023. doi: 10.4240/wjgs.v15.i3.307
Surgical management of acute pancreatitis: Historical perspectives, challenges, and current management approaches
Nasser Alzerwi
Nasser Alzerwi, Department of Surgery, Majmaah University, Riyadh 11952, Saudi Arabia
Author contributions: Alzerwi N conducted literature review, analysis, and manuscript writing.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Nasser Alzerwi, MBBS, SBGS, ABGS, FSMC(HPB), Associate Professor, Department of Surgery, Majmaah University, P. O. Box 66, Al-Majmaah City, Riyadh Region, Riyadh 11952, Saudi Arabia. n.alzerwi@mu.edu.sa
Received: September 21, 2022 Peer-review started: September 21, 2022 First decision: October 21, 2022 Revised: November 19, 2022 Accepted: February 14, 2023 Article in press: February 14, 2023 Published online: March 27, 2023 Processing time: 187 Days and 9.8 Hours
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.
Core Tip: The surgical management of acute pancreatitis has evolved substantially during the last several decades. Conservative therapy is frequently more effective than surgery; nonetheless, surgical treatments are required in cases of non-responsive or complication-prone patients. Such cases may be treated using endoscopic, percutaneous, or open procedures, each with its own set of benefits and risks. Before settling on an acceptable surgical procedure, the AP severity, phase, and anatomical restrictions must be thoroughly reviewed for optimal clinical outcomes.
