Debates and countermeasures in the management of infection secondary to severe acute pancreatitis

SUN Bei; JI Liang

doi:10.19538/j.cjps.issn1005-2208.2018.01.10

Abstract：There are five emerging characteristics present in the modern surgical management of infection secondary to severe acute pancreatitis (SAP) under the guidance of step-up approach:minimal invasive,staged,multi-disciplinary,specialized and diversified.The administration of step-up approach conforms to 3D principle:surgical interventions should be relatively delayed to the end of the 4th week approximately,the first choice of intervention is drainage and debridement is warranted if drainage failed.A favorable evaluation of documented and/or suspected infection places emphasis on a precise imaging reading and a comprehensive analysis in combination with other clinical findings,taking a possibility of infections in other system/ organs into account.Medical therapy alone is only suitable for documented/suspected patients whose illness is stable and with no obvious signs of sepsis and/or organ failure.As a minimal invasive intervention,imaging-guided PCD could be relatively conducted early.Multiple organ failure and heterogeneous lesion are explicit risk factors independently associated with the requirement of debridement for patients with secondary infection.A specific step-up protocol in the management of infection secondary to SAP is determined by location and distribution of the lesion as well as preference of the surgeon in charge,under the ultimate consideration of avoiding hemorrhage and intestinal fistula.The open debridement in the step-up approach is performed at the appropriate timing under the right indication,so it is safe,available and irreplaceable.There is a prominent insufficiency in the surgical management of infection secondary to SAP,surgeons thus should endeavor to establish their predominant role in the multiple disciplinary therapy and fight for a favorable prognosis for the patients.