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[Therapeutic strategy in acute pancreatitis (II). Surgical procedure].

When operative treatment of acute hemorrhagic necrotizing pancreatitis becomes unavailable, one should aim for a delayed procedure if at all possible. The best results with a mortality of only 29% are achieved by radical necrosectomy and postoperative lavage and suction drainage. An additional considerable improvement could be achieved during the last months by employing preoperative ERCP. Only one out of 15 patients died. Visualization of the pancreatic duct allows e.g. pancreatic fistulae to be identified which absolutely have to be removed during the operation.