Current issues related to treatment of acute pancreatitis from the surgeon's point of view

In recent times, the surgical treatment of acute pancreatitis has significantly changed. Indication and the surgical techniques for emergency operations are basically similar to the previous practice but new indication area has appeared. Abdominal compartment syndrome is an immediate indication for surgery if conservative and semi -conservative therapy is failed or ineffective. In these cases, decompressive laparotomy and open abdomen treatment combined with vacuum therapy are currently recommended. Instead of conventional pancreatic necrosectomy, minimal invasive procedures became more often used. Operations are suggested to be performed in the late stages of the disease when the so-called walled -off pancreatic necrosis has developed. Nowadays, the first -line treatment for walledoff pancreatic necrosis is endoscopic endoluminal transgastric necrotomy, but in extensive cases and if the wall of the necrotic cavity is too thick and cholecystectomy is also necessary, laparoscopic or open transgastric necrotomy is justified. The authors analyze the changes in surgical treatments and also cover the issues of indications for operations and surgical techniques.