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BIOGRAPHICAL SKETCH
Name: Alejandra Guillermina Miranda Díaz
Affiliation: Department Of Physiology, University Health Sciences
Centre, University of Guadalajara (Centro Universitario de Ciencias de la
Salud, Universidad de Guadalajara), Guadalajara, Jalisco, México
Education: MD, FACS, Master in Sc, PhD
Address: Avenida La Paz 2758, Arcos Sur, CP 44150, Guadalajara,
Jalisco México
Research and Professional Experience: General Surgeon, Profesor and
Investigator, Department Of Physiology, University Health Sciences Centre,
University of Guadalajara (Centro Universitario de Ciencias de la Salud,
Universidad de Guadalajara), Guadalajara, Jalisco, México
Professional Appointments: Avenida La Paz 2758, Arcos Sur, CP
44150, Guadalajara, Jalisco México
Honors:
Publications Last 3 Years:
The effect of ubiquinone and combined antioxidant therapy on
oxidative stress markers in non-proliferative diabetic retinopathy: A
phase IIa, randomized, double-blind, and placebo-controlled study.
Severe Acute Pancreatitis: Since the Classical
107
Effects of Ezetimibe/Simvastatin and Rosuvastatin on Oxidative
Stress in Diabetic Neuropathy: A Randomized, Double-Blind,
Placebo-Controlled Clinical Trial.
The antioxidant effect of ubiquinone and combined therapy on
mitochondrial function in blood cells in non-proliferative diabetic
retinopathy: A randomized, double-blind, phase IIa, placebo-
controlled study.
Toll-like receptor-1 and receptor-2 and Beta-defensin in
postcholecystectomy bile duct injury.
Effect of necrosectomy and vacuum-assisted closure (VAC) on
mitochondrial function and oxidative stress markers in severe acute
pancreatitis.
Effect of rosuvastatin on diabetic polyneuropathy: a randomized,
double-blind, placebo-controlled Phase IIa study.
Effect of botulinum toxin type A in lateral abdominal wall muscles
thickness and length of patients with midline incisional hernia
secondary to open abdomen management.
Oxidants, antioxidants and mitochondrial function in non-proliferative
diabetic retinopathy.
The effect of ubiquinone in diabetic polyneuropathy: a randomized
double-blind placebo-controlled study.
In: Acute Pancreatitis ISBN: 978-1-63485-229-6
Editor: Shane Copeland © 2016 Nova Science Publishers, Inc.
Chapter 6
MANAGEMENT OF ACUTE
BILIARY PANCREATITIS
Vincenzo Neri, Professor, Dr Med
General Surgery, University of Foggia, Italy
ABSTRACT
Acute pancreatitis is a complex gastrointestinal disease with various
etiology, most frequent biliary and alcoholic (70-80%). Biliary lithiasis
can be considered the most common cause of acute pancreatitis. The
complete diagnostic study should be necessary because etiologic
assessment can be a guide for surgery in the therapeutic program. The
very diversified territorial distribution of the various clinical and
etiological forms of pancreatitis generated uncertainties. In fact in our
experience we can assume the prevalence of biliary etiology with the
pathogenesis based on obstacle in the papillary patency. The etiological
assessment can be a guide in the therapeutic programmes. The biliary
etiology at the initial assessment has been defined by the evaluation of
liver function tests and cholestasis exams and by the research, on
abdominal US, of gallbladder lithiasis, and/or gallstones, sludge,
microlithiasis in the common bile duct. The following diagnostic tools,
MRCP and/or endoscopic US confirmed the biliary origin of pancreatitis.
Acute pancreatitis in the majority of patients (70-80%) present with a
mild-moderate disease that need only fluid rehydratation and abdominal
pain control. On the contrary 20-30% shows a severe curse. Severe acute
pancreatitis can be seen a biphasic disease: first phase (1-2 weeks)
characterized by early toxic-enzymatic action and evolution in SIRS-
Vincenzo Neri
110
MODS; the later phase (3-4 weeks) with septic complications of
pancreatic-peripancreatic fluid necrotic gatherings. Based on this criteria
therapeutic program usually develops in 2 phases. In the severe forms the
therapeutic program has the purpose to control and treat, by intensive
care, the impairment of the general conditions. In particular in the acute
biliary pancreatitis the control of papillary patency and its treatment with
ERCP/ES within 3-4 days is the cornerstone of therapeutic program,
based on the confirmation of papillary obstacle by US/MRCP or if is
present cholestasis or cholangitis. For the treatment of further evolution
of necrotizing pancreatitis there are some specific surgical decisions
based on the following questions:
How long the control and observation of not complicated fluid-
necrotic gatherings may be prolonged?
How to differentiate infected pancreatic necrosis from those sterile?
In some patients with infected necrosis may be delayed the surgical
treatment?
Which is the best surgical approach and its time for the treatment of
the fluid necrotic complicated gatherings?
The surgical procedures showed a progressive evolution to
miniinvasivity: percutaneous drainage, endoscopic drainage,
necrosectomy with minimally invasive step-up approach, endoscopic
transluminal necrosectomy (ETN), videoassisted retroperitoneal
debridment (VARD). About the surgical time there is almost unanimous
consensus to delay the intervention until the fluid necrotic collections are
encapsulated (walled off necrosis).
In conclusion in severe, moderate severe, recurrent acute pancreatitis
with cholestasis-cholangitis, or instrumental confirmation (US/MRCP) of
papillary or CDB obstacle is indicated the therapeutic ERCP/ES within 3-
4 days. In septic necrotic collections the role of the surgery should be
limited to percutaneous drainage (that in most cases could reduce the
needs for surgery). If major surgical interventions are required, these
should be more conservative as possible and preferred minimally invasive
approaches.
Keywords: acute biliary pancreatitis, ERCP/ES, pancreatic gatherings
INTRODUCTION
Acute pancreatitis (AP) is an inflammatory disease of the pancreas with
systemic response to auto-digestion of the glandular and peri-pancreatic tissue.