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World J Gastrointest Surg. Mar 27, 2023; 15(3): 307-322
Published online Mar 27, 2023. doi: 10.4240/wjgs.v15.i3.307
Table 1 Acute pancreatitis diagnosis, classification, and indications for surgery

Criteria
Diagnosis of AP (any two)Abdominal pain
Serum lipase or amylase anomalies
Characteristic radiological features
Mild AP1No OF
Absence of local or systemic complications
Moderately severe AP1Transient OF (resolves in < 48 h)
Local or systemic complications without persistent OF
Severe AP1Persistent OF
Key indications for surgeryInfected necrosis
Complications of pancreatitis
Fistulas
Pseudocyst
Recurrent AP
Abdominal compartment syndrome
Systemic inflammatory response syndrome
Acute necrotizing cholecystitis or intestinal ischemia
Acute bleeding due to a failed endovascular approach
Table 2 Summary of key surgical recommendations in different guidelines for acute pancreatitis management
IAP1 (grade A and B)[31]
WSES2 (grade 1A, 1B, or 1C)[4]
AGA (pancreatic necrosis)[33]
Mild AP is not an indication for pancreatic surgery (grade B recommendation)Routine ERCP is not indicated (1A)Drainage and/or debridement of pancreatic necrosis is indicated in patients with IPN
IPN in patients with clinical signs and symptoms of sepsis is an indication for intervention (recommendation grade B)ERCP is indicated in patients with GSAP and cholangitis (1B)Pancreatic debridement should be avoided in the early, acute period (first two weeks)
Early surgery is not recommended within 14 d after the onset of the disease in patients with necrotic pancreatitis (recommendation grade B)Clinical deterioration with signs of INP is an indication of intervention (1C)Percutaneous and transmural ED are both appropriate first-line nonsurgical approaches to the management of patients with WON
Interventional management should favor an organ-preserving approach (grade B recommendation)As a continuum in a step-up approach after percutaneous/endoscopic procedure (1C)Percutaneous drainage of pancreatic necrosis should be considered in patients with infected or symptomatic necrotic collections in the early acute period (< 2 wk)
ES is an alternative to cholecystectomy in those who are not fit to undergo surgery (grade B recommendation)In IPN, percutaneous drainage as the first-line of treatment (1A)SEMS in the form of LAMS appears superior to plastic stents for endoscopic transmural drainage of necrosis
Minimally invasive surgical strategies result in fewer postoperative new-onset OF (1B)The use of DEN should be reserved for those patients with limited necrosis and not responding to endoscopic transmural drainage
Laparoscopic cholecystectomy is recommended during index admission in mild GSAP (1A)Minimally invasive operative approaches to the debridement of IPN are preferred to open approaches
The risk of recurrent pancreatitis is reduced when ERCP and sphincterotomy are performed during index admission (1B)
Over-resuscitation of patients with early SAP should be avoided; intra-abdominal pressure monitoring is necessary (1C)A step-up approach consisting of percutaneous drainage or endoscopic transmural drainage, followed by DEN, and then surgical debridement is reasonable
OA should be avoided if other strategies can be used to manage IAH (1C)
Not to use OA after necrosectomy (1C)
Not to debride or perform an early necrosectomy if forced to perform an early OA due to ACS (1A)
For patients with disconnected left pancreatic remnants after acute necrotizing mid-body necrosis, definitive surgical management with distal pancreatectomy can be performed