IMPLEMENTATION OF THE CONCEPT OF «FAST-TRACK SURGERY» IN THE TREATMENT OF PATIENTS WITH ACUTE PANCREATITIS ACCORDING TO THE TACTICS «STEP-UP APPROACH»
Summary. The aim of the study – to improve the results of surgical treatment of patients with acute pancreatitis using the “step-up approach” tactics, and justify the feasibility of implementing the concept of “fast-track surgery” in surgical practice using the example of these patients.
Matherials and Methods of the study. The results of the treatment of 103 patients with acute pancreatitis who were treated in the surgical department of the Municipal non-commercial enterprise of the Kharkov regional council «Regional Clinical Hospital» 2015 to 2020 were analyzed. All patients were divided into two groups: the main (56 patients) and the comparison group (47 patients). In the main group, the tactics of the “step-up approach” were applied and the principles of the ERAS concept (2018-2020) were implemented. In the comparison group (2015-2017), the ERAS principles were not implemented and the open method was mainly used as the standard surgical treatment.
Results of the study. Patients treated using the principles of “fast-track surgery” along with the “step-up approach” tactics, less likely to have postoperative complications and reduced the length of stay in the surgical department.
Conclusions. This example confirms the appropriateness of applying the principles of “fast-track surgery” in everyday surgical practice in the complex treatment of patients with acute pancreatitis, as the results of surgical treatment of this category of patients are improved and financial costs for treatment are reduced.
2. Darrivere L., Lapidus N., Colignon N. et al. Minimally invasive drainage in critically ill patients with severe necrotizing pancreatitis is associated with better outcomes: an observational study. Critical Care. 2018; 22: 321. P. 299-321.
3. Goodchild G., et al. Review Practical guide to the management of acute pancreatitis. Frontline Gastroenterology. – 2019, 10. P. 292-299 DOI: 10.1136/flgastro-2018-101102
4. Gurusamy K.S., Belgaumkar A.P. et al. Interventions for necrotising pancreatitis (review). Cochrane Database of Systematic Reviews. 2016, Issue 4. Art. No.: CD011383. 83 p. DOI: 10.1002/14651858.CD011383.pub2.
5. Leppaniemi Ari et al. 2019 WSES guideliners for the management of severe acute pancreatitis. World Journal of Emergency Surgery. – 2019. 14:27. 20 p. https://doi.org/10.1186/s13017-019-0247-0
6. Peter A. Banks, Thomas L. Bollen et al. Classification of acute pancreatitis – 2012: revision of the Atlanta classification and definitions by international consensus. Pancreas. – 2013. 62: P.102-111. DOI 10.1136/gutjnl-2012-302779
7. Sion M.K., Davis K.A. Step-up approach for the management of pancreatic necrosis: a review of the literature. Trauma Surgery & Acute Care Open. 2019; 4:e000308. 5 p. DOI:10.1136/tsaco-2019-000308
8. Working Group IAP/APA Acute Pancreatitis Guidelines. IAP/APA evidence-based guidelines for the management of acute pancreatitis. Pancreatology 13 (2013). 15 p. http://dx.doi.org/10.1016/j.pan.2013.07.063