Complicated acute pancreatitis : Interventions and timing of treatment

The aim of the studies described in this thesis is to optimize the treatment in patients with complicated acute pancreatitis. In a cohort of 108 patients with infected necrotizing pancreatitis undergoing a video-assisted retroperitoneal debridement (VARD), in hospital death was 15.7%. The studies shows that VARD is being increasingly postponed and the number of pre-necrosectomy drainages increases, but an optimal timing of the necrosectomy remains unclear. There is currently no consensus on the timing of the primary drainage. This thesis presents the rationale and design of the randomized controlled POINTER trial, which investigates whether immediate drainages is superior to the current practice of postponed drainages (until the stage of walled-off necrosis). An important complication of necrotizing pancreatitis is the occurrence of a disconnected or disrupted pancreatic duct. This thesis explores the treatment options for this condition and the diagnostic modalities that could be used for this condition. Furthermore the use of the comprehensive complication index in infected necrotizing pancreatitis was validated as primary outcome measure. Finally we assessed patients’ dominant clinical symptoms and their opinions regarding the most relevant clinical research topics in pancreatitis.