Further understanding of surgical intervention for severe acute pancreatitis in the era of step-up approach

WANG Gang; XU De-quan; ZHOU Hao-xin

doi:10.19538/j.cjps.issn1005-2208.2024.05.06

Abstract：In the past decade or so,the step-up approach has become the mainstream surgical intervention model for severe acute pancreatitis(SAP).However,the complexity and variability condition of SAP,coupled with the rapid development of minimally invasive concepts and technologies,make it worthwhile for us to deeply consider how to maximize the benefits of surgical intervention for patients in the context of step-up approach.The establishment of subtypes for infectious pancreatic necrosis(IPN)has important clinical significance,which means that the treatment of different types of IPN cannot be limited to a single strategy.In some cases,traditional intervention models can be broken and a leapfrog intervention model can be adopted as a supplement and improvement to the step-up approach.The multidisciplinary tream(MDT)model runs through the entire process of individualized treatment in SAP,surgeons still play an irreplaceable role in the personalized comprehensive treatment of SAP.At present,we still need to develop personalized,precise,and minimally invasive intervention plans based on the specific situation of patients,disciplines,and the technical characteristics of doctors.Open debridement,as an important component of the step-up approach,should be carried out in a planned manner with reasonable indications and timing,and should not be neglected.In the era of stepwise treatment,it is necessary to follow the strategy of switching between progressive and leapfrog interventions as needed,emphasizing both surgical and endoscopic intervention methods,and establishing an efficient and unified MDT diagnosis and treatment platform,to further improve the overall cure rate of SAP.