https://scientific-jl.com/luch/
Часть-44_ Том-1_ Май-2025
519
A DIFFERENTIATED SURGICAL APPROACH IN ACUTE
PANCREATITIS: OUTCOME PREDICTION AND TREATMENT
OPTIMIZATION
Rizaev E. A.,
Babakulov Sh. H,
Sayfiddinov A. A.
Tashkent state dental institute Uzbekistan
Keywords: acute pancreatitis, necrotizing pancreatitis, minimally invasive
surgery, open necrosectomy, ERCP, treatment outcomes, APACHE II, SOFA.
Background:
Acute pancreatitis (AP) is a life-threatening abdominal emergency with increasing
incidence and significant morbidity and mortality. Severe forms often involve
necrotizing pancreatitis, with up to 30–70% mortality in infected cases. Current
surgical approaches remain controversial, particularly in choosing between open
and minimally invasive techniques during different disease phases. This study
aimed to develop and evaluate a differentiated, evidence-based surgical strategy to
improve outcomes in patients with severe AP.
Methods:
A prospective observational study was conducted involving 261 patients treated for
acute pancreatitis between 2018 and 2023. Patients were stratified into groups
based on the presence of aseptic (n=107) or infected necrosis (n=75). Treatment
modalities included conservative therapy, minimally invasive procedures (video-
laparoscopy, ultrasound-guided percutaneous drainage), and open surgery. Disease
severity and therapeutic outcomes were assessed using APACHE II and SOFA
scores before and after intervention. ERCP with endoscopic sphincterotomy (EST)
was applied in cases of biliary AP.
https://scientific-jl.com/luch/
Часть-44_ Том-1_ Май-2025
520
Results:
Minimally invasive approaches demonstrated significant benefits in patients with
aseptic necrosis, reducing mortality to 6.2% compared to 17.2% in the open surgery
group. In infected necrosis, open surgery achieved better outcomes (mortality
19.1%) than minimally invasive treatment (27.3%). Early endoscopic interventions
in biliary AP effectively relieved ductal hypertension and reduced progression to
necrosis. SOFA and APACHE II scores improved more rapidly in patients
undergoing minimally invasive procedures in the early disease phase, while open
interventions proved superior in late septic stages with extensive necrosis.
Conclusion:
A phase-specific, differentiated surgical approach significantly improves treatment
outcomes in acute pancreatitis. Minimally invasive methods are optimal during
early aseptic stages, offering lower mortality and reduced postoperative
complications. Open surgery remains necessary in managing late-stage infected
necrosis. Integrating clinical severity scores allows for better prediction of
outcomes and surgical decision-making. These findings support an individualized,
evidence-based treatment algorithm for acute pancreatitis management.
