[Acute pancreatitis. Our experience during 20 years]. / Pancreatite acuta. La nostra esperienza nell'arco di venti anni.

ABSTRACT

BACKGROUND: On the basis of personal experience and studies, the importance to diagnose quickly the seriousness of an acute pancreatitis with the help of simple and credible criteria of evaluation is underlined. It's also underlined the help of endoscopic papillosphincterotomy in the initial phase of a biliary pancreatitis; in fact this exam permits to perform a laparoscopic cholecystectomy in a second time and reduce surgical trauma. METHODS: Personal experience with 288 cases of acute pancreatitis (AP), during a twenty-year period (1975-1996) is described. In 61% of cases the AP was associated with biliary illness, and in 13% with alcohol abuse. Real important for therapeutic implication and prognostic significance is the classification of severity of acute attack, by using clinical evaluation (pain, fever, jaundice, abdominal tenderness), multiparametric score (i.e. Imrie's score, Ranson's criteria, SAPS or APACHE II score system) and morphological evaluation of the pancreas (echo and CT scan). 151 patients have been admitted at different times to surgery, the cholecystectomy being the more common surgical procedure, with a surgical rate of 52%. RESULTS: The overall mortality has been 7.2%, ranging from 45.4% in 17 severe necrotic haemorrhagic AP to 2.1% for the mild one. CONCLUSIONS: The widespread use of endoscopic retrograde colangiopancreatography (associated to endoscopic sphincterotomy if necessary) and the recent but universally accepted diffusion of laparoscopic cholecystectomy have changed the modern approach to surgical treatment of biliary associated AP, ensuring mininvasive less traumatic surgical procedures.