Pancreatonecrosis takes place in three phases:
- phase of toxemia;
- phase of abscess;
- phase of purulent changes.
The third phase of this disease is treated with a surgical method, but for the first two phases to conduct or not to perform the operation - the opinions of the surgeons are contradictory. Some doctors recommend early operations in the form of pancreas abdominization, laparotomy and removal of the affected tissue. Others consider this method of treatment unjustifiably risky and recommend conducting it after conservative therapy.
Anyway, indications for surgical treatment will be the presence of purulent changes and inefficiency of conservative therapy. Most modern surgeons conducting pancreatic necrosis surgery share all the surgical procedures performed on:
- Emergency - those that perform the field during the first 24 hours of hospitalization of the patient. Such interventions should not be unjustifiably large radical because of the risk of intolerance on the part of the patient. Basically, such operations are omentobursostomiya, drainage of the gland bag, exudate output, laparotomy. In carrying out these interventions, it is worthwhile to adequately assess the chance of survival for a patient with pancreatic necrosis, since the death rate during draining of the gland bag reaches 50%, and with omentobursostomy - up to 25%.
- Urgent operations are performed if conservative therapy for three days has proved ineffective and the disease continues to progress. Mortality in these operations is more than half the death rate from emergency surgery and almost three times lower than those of the same manipulations performed in the late treatment of pancreatic necrosis.
- Late operations of pancreatic necrosis. Late surgical interventions include those that take place after two weeks from the onset of the disease in patients. Indication for such an intervention is the progression of the disease, despite adequate conservative treatment.
The main problem of surgical treatment of patients with pancreatic necrosis is not rehabilitation after surgery and failure to follow the recommendations of a doctor. It's not a diet based on a strict diet, but different interpretations and representations of doctors about the appropriateness, nature and timing of surgical interventions, as well as the lack of development of such a unified sequence of surgical procedures that would reduce the mortality of patients after pancreatonecrosis surgery.
Pancreatic necrosis after operation
In the postoperative period, patients with pancreatic necrosis of the pancreas need a detailed and long-term follow-up of specialists. They may experience complications in the form of fistulas, cysts, which require repeated surgical intervention. Also, the percentage of diabetes is high enough, therefore, it is necessary to observe the endocrinologist and take medications to regulate sugar in the blood. The patient should be on a regular dispensary account and be examined every six months. It includes laboratory tests, ultrasound, x-ray, computer and magnetic resonance imaging.
Absolutely necessary condition is considered a strict diet. Therapeutic diet begins before the operation. The patient is not allowed to eat any food and instead of it a composition with fats, amino acids and glucose is injected into the blood. After the operation, the same food lasts for five days. Then it is allowed to take a rose hip tincture - up to 4 glasses per day. If the patient's physical condition is not deteriorating, a strict diet without salt and fat is prescribed. Gradually, the range of products can be expanded. However, fried, fatty, spicy foods, alcohol and overeating are definitely excluded.
In the menu after surgery, pancreatic necrosis includes biscuits, dried baked goods and unsweetened biscuits.
Nonfat fish, meat in boiled, stewed and wiped form are allowed.
Fatty, rich broths are excluded.
Favorable consumption of ripe and soft fruits, except grapes, as well as fresh juices, unsweetened tea and compote.
It is desirable to eat low-fat cottage cheese and sour-milk products.
Salt in the diet should be present in the amount of 2 g per day, cream and sunflower oil - up to 10 g only in the composition of dishes.