Surgical intervention in severe acute pancreatitis: 476 cases in 20 years.

During a 20-year period 1967-86, 476 consecutive cases of severe acute pancreatitis were managed by one surgeon (GAK) and the role and results of surgical intervention in this group were reviewed. Of the 173 cases undergoing surgery, 77 were laparotomies for diagnosis, seven for the excision of necrotic pancreatic tissue and 89 for postpancreatitis complications (18 pseudocysts, 53 pancreatic abscesses, one large bowel perforation, 17 patients with persistent obstructive jaundice and one case of acute haemorrhage into a cyst causing obstructive jaundice). There were 50 deaths (11%) of whom 38 died early in the course of the disease, two died following total pancreatectomy and 10 died as a consequence of a pancreatic abscess. Based on this experience and on the current understanding of this condition, the place of surgery in severe acute pancreatitis is discussed briefly.