• Paolo De Rai, Alessandro Zerbi, Laura Castoldi, Claudio Bassi, Luca Frulloni, Generoso Uomo, Armando Gabbrielli, Raffaele Pezzilli, Giorgio Cavallini, Valerio Di Carlo, and ProInf-AISP (Progetto Informatizzato Pancreatite Acuta, Associazione Italiana per lo Studio del Pancreas [Computerized Project on Acute Pancreatitis, Italian Association for the Study of the Pancreas]) Study Group.
• Department of Surgery and Emergency Surgery, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS [Institute for Scientific Care and Treatment]) Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy. pderai@policlinico.mi.it
• HPB (Oxford). 2010 Nov 1; 12 (9): 597-604.

ObjectiveThis study aimed to evaluate the surgical treatment of acute pancreatitis in Italy and to assess compliance with international guidelines.MethodsA series of 1173 patients in 56 hospitals were prospectively enrolled and their data analysed.ResultsTwenty-nine patients with severe pancreatitis underwent surgical intervention. Necrosectomy was performed in 26 patients, associated with postoperative lavage in 70% of cases. A feeding jejunostomy was added in 37% of cases. Mortality was 21%. Of the patients with mild pancreatitis, 714 patients with a biliary aetiology were evaluated. Prophylactic treatment of relapses was carried out in 212 patients (36%) by cholecystectomy and in 161 using a laparoscopic approach. Preoperative endoscopic retrograde cholangiopancreatography was associated with cholecystectomy in 83 patients (39%). Forty-seven patients (22%) were treated at a second admission, with a median delay of 31 days from the onset of pancreatitis. Eighteen patients with severe pancreatitis underwent cholecystectomy 37.9 days after the first admission. There were no deaths.DiscussionThe results indicate poor compliance with published guidelines. In severe pancreatitis, early surgical intervention is frequently performed and enteral feeding is seldom used. Only a small number of patients with mild biliary pancreatitis undergo definitive treatment (i.e. cholecystectomy) within 4 weeks of the onset of pancreatitis.© 2010 International Hepato-Pancreato-Biliary Association.

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