IAP guidelines for the surgical management of acute pancreatitis

Waldemar Uhl, Andrew Warshaw, Clement Imrie, Claudio Bassi, Colin J. McKay, Paul G. Lankisch, Ross Carter, Eugene Di Magno, Peter A. Banks, David C. Whitcomb, Christos Dervenis, Charles D. Ulrich, Kat Satake, Paula Ghaneh, Werner Hartwig, Jens Werner, Gerry McEntee, John P. Neoptolemos, Markus W. Büchler*, Jose EduardoSonia Penteado, Oleg Tcholakav, Peter Balaz, Steen Larsen, Else K. Philipsen, Marko Lempinen, René Laugier, Hans Guenter Becker, Pascal Berberat, Fabio F. Di Mola, Pierluigi Di Sebastiano, Ahmed Guweidhi, Mark Hartel, Jorg Kleeff, Christophe Mueller, Bruno Schmied, Tobias Keck, E. Chatzitheoklitos, Gregory Tsiotos, Laszlo Czako, Tamas Takacs, D. Dezso Kelemen, Attila Olah, Tibor F. Tihanyi, Tooru Shimosegawa, Guillermo Robles-Diaz, Andres Duarte-Rojo, Andrzej Dabrowski, Jan Dlugosz, Wereszczynska Sremietkowska Bialystok, Zycmuni Warzecha, Antonio Marques, Faustino P. Reis, Barbu Traian-Sorin, Alojz Pleskovic, J. Enrique Dominguez-Munoz, Julio Iglesias Garcia, Augusto Villanueva, Luisa Guarner, Donald Jose Vasquez-Cruz, Miguel Perez-Mateo, Anders Borgstöm, Fernando Ruizjasbon, Berit Sternby, Beat Gloor, Malcolm Aldridge, Derek O'Reilly, Peter Hegyi, Rohit Makhija, Mark Midwinter, Satvinder S. Mudan, Ioannis Virlos, Andre A. Perejaslov, Roman E. Vatseba, Woody Denham, William H. Nealon, Tamara Alempijevic, Knezevic Djordje, Lili Petronijevic, Dejad Radeukovic, Dugalic Vladimir, S. Matsuno, K. Kashima, M. V. Singer, P. Bornman, E. Dominguez-Monoz, C. F. del Castillo, K. Inoue, M. Lerch, P. Levy, J. E. Monteiro, A. Pap, A. Pap, R. Pezzili, S. Lazzaro di Savena, C. Pitchumoni, G. Robles-Diaz, Youkouchoi Ashiya, R. Schmid, T. Shimosegawa, M. Tempero, G. G. Tsiotos, M. Vaccaro, J. Wilson

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

711 Scopus citations


During 2002 the International Association of Pancreatology developed evidenced-based guidelines on the surgical management of acute pancreatitis. There were 11 guidelines, 10 of which were recommendations grade B and one (the second) grade A. (1) Mild acute pancreatitis is not an indication for pancreatic surgery. (2) The use of prophylactic broad-spectrum antibiotics reduces infection rates in computed tomography-proven necrotizing pancreatitis but may not improve survival. (3) Fine-needle aspiration for bacteriology should be performed to differentiate between sterile and infected pancreatic necrosis in patients with sepsis syndrome. (4) Infected pancreatic necrosis in patients with clinical signs and symptoms of sepsis is an indication for intervention including surgery and radiological drainage. (5) Patients with sterile pancreatic necrosis (with negative fine-needle aspiration for bacteriology) should be managed conservatively and only undergo intervention in selected cases. (6) Early surgery within 14 days after onset of the disease is not recommended in patients with necrotizing pancreatitis unless there are specific indications. (7) Surgical and other forms of interventional management should favor an organ-preserving approach, which involves debridement or necrosectomy combined with a postoperative management concept that maximizes postoperative evacuation of retroperitoneal debris and exudate. (8) Cholecystectomy should be performed to avoid recurrence of gallstone-associated acute pancreatitis. (9) In mild gallstone-associated acute pancreatitis, cholecystectomy should be performed as soon as the patient has recovered and ideally during the same hospital admission. (10) In severe gallstone-associated acute pancreatitis, cholecystectomy should be delayed until there is sufficient resolution of the inflammatory response and clinical recovery. (11) Endoscopic sphincterotomy is an alternative to cholecystectomy in those who are not fit to undergo surgery in order to lower the risk of recurrence of gallstone-associated acute pancreatitis. There is however a theoretical risk of introducing infection into sterile pancreatic necrosis. These guidelines should now form the basis for audit studies in order to determine the quality of patient care delivery. Copyright

Original languageEnglish (US)
Pages (from-to)565-573
Number of pages9
Issue number6
StatePublished - 2002

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Hepatology
  • Gastroenterology


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