Surgery and Aetiology

Surgery is really only reserved for selected cases when pancreatitis is complicated by pancreatic or peripancreatic (abdominal fatty tissue) necrosis; the timing of surgery will be dependent on many factors including the patients clinical condition, presence of infection and degree of necrosis, and is largely the surgical teams decision. Minimally invasive step up approach are recommended over open necrosectomy for necrotising pancreatitis, starting with conservative management and then to either percutaneous drainage or endoscopic transluminal drainage.

Patient with gallstone pancreatitis will be considered for cholecystectomy when they are well enough for surgery. If they are surgically unfit or frail, ERCP with biliary sphincterotomy may be considered, but risk should be balanced against risk of recurrent biliary events. 

The aetiology of the pancreatitis should be attempted to be determined if it has not already; a diagnosis of idiopathic disease should not be made until a thorough consideration of other causes has been made. This may necessitate revisiting the history, further abdominal USS, magnetic resonance cholangiopancreatography (MRCP), endoscopic USS, viral antibody titres, autoimmune markers and ERCP.

Learning Bite

Good supportive care rather than surgery is the mainstay of the management of pancreatitis.