Kazan medical journalKazan medical journal0368-48142587-9359Eco-Vector564010.17750/KMJ2016-898Research ArticleSurgical tactics in patients with pancreatic necrosis and its complicationsKrasil’nikovD Maabdulianov@mail.ruAbdul’janovA Vaabdulianov@mail.ruZajnullinI Vaabdulianov@mail.ruBorodinM Aaabdulianov@mail.ruZefirovR Aaabdulianov@mail.ruImamovaA Maabdulianov@mail.ruKazan State Medical UniversityRepublican Clinical Hospital1512201697689890318112016Copyright © 2016, Krasil’nikov D.M., Abdul’janov A.V., Zajnullin I.V., Borodin M.A., Zefirov R.A., Imamova A.M.2016<p><strong>Aim.</strong> Improving the results of surgical treatment of patients with pancreatic necrosis and its complications based on developing optimal variants of surgical interventions for each case.</p><p><strong>Methods.</strong> The article presents experience of surgical treatment of 344 patients with pancreatic necrosis admitted to surgical clinic №1 of Kazan state medical university in Republican clinical hospital (Kazan) during the period from 2009 to 2015. According to the developed procedure of choosing the optimal treatment options for patients with pancreatic necrosis, depending on the stage, degree of involvement of pancreas and retroperitoneal space and the presence of complications, patients underwent a variety of options and combinations of types of surgical interventions. Under the guidance of X-ray 124 surgeries were performed, in 69 (20.1%) cases surgical interventions under ultrasound (US) guidance were completed with open surgical intervention.</p><p><strong>Results.</strong> Videolaparoscopic interventions with therapeutic and diagnostic purposes were performed in 198 patients with lethal outcomes in 3 (3.1%) cases. As a completed intervention videolaparoscopy was performed in 49 (24.7%) cases. 226 (65.7%) patients underwent open surgery. Most patients required combined surgical treatment, which included a combination of minimally invasive procedures and open surgery in 199 (57.9%) patients.</p><p><strong>Conclusion.</strong> Use of combined methods of surgical treatment in patients with infected pancreatic necrosis greatly improves treatment outcomes; a combination of minimally invasive and open surgery can significantly reduce postoperative mortality in pancreatic necrosis from 17.8% to 12.5%.</p>acute pancreatitispancreatic necrosisminimally invasive interventionscombined surgical treatmentendoscopyострый панкреатитпанкреонекрозмалоинвазивные вмешательствакомбинированное оперативное лечениеэндоскопияострый панкреатитпанкреонекрозмалоинвазивные вмешательствакомбинированное оперативное лечениеэндоскопия[Гальперин Э.И., Дюжева Т.Г. Панкреонекроз: неиспользованные резервы лечения. Анн. хир. гепатол. 2007; 12 (2): 46-51.][Багненко С.Ф., Благовестников Д.А., Гальперин Э.И. и др. Острый панкреатит (протоколы, диагностика и лечение). Материалы круглого стола: диагностика и лечение острого панкреатита. М. 2014; 8-10.][Дарвин В.В., Онищенко С.В., Краснов Е.А. и др. Острый деструктивный панкреатит: современное хирургическое лечение. Анн. хир. гепатол. 2014; (4): 76-82.][Ермолов А.С., Иванов П.А., Благовестнов Д.А. и др. Диагностика и лечение острого панкреатита. М.: Видар-М. 2013; 382 с.][Красильников Д.М., Абдульянов А.В., Бородин М.А. Оптимизация хирургического лечения больных панкреонекрозом. Анн. хир. гепатол. 2011; 16 (1): 66-71.][Прудков М.И. Клинические рекомендации по оказанию медицинской помощи населению Уральского Федерального округа. Екатеринбург. 2013; 23-29.][Савельев B.C., Филимонов М.И., Гельфанд Б.Р. и др. Панкреонекроз: актуальные вопросы классификации, диагностики и лечения (результаты анкетирования хирургических клиник Российской Федерации). Consil. Med. 2000; 2 (7): 34-39.][Aggarwal A., Manrai M., Kochhar R. Fluid resuscitation in acute pancreatitis. World J. Gastroenterol. 2014; 20 (48): 18092-18103. http://dx.doi.org/10.3748/wjg.v20.i48.18092][Beger H.G., Rau B., Isenmann R. Natural history of necrotizing pancreatitis. Pancreatology. 2013; 5: 93-101. https://dx.doi.org/10.1159/000070076][Mouli V.P., Sreenivas V., Garg P.K. Efficacy of conservative treatment, without necrosectomy, for infected pancreatic necrosis: a systematic review and metaanalysis. Gastroenterology. 2012; 144 (2): 333-340. http://dx.doi.org/10.1053/j.gastro.2012.10.004]