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This study by van Brunschott and international colleagues1 has shown that when possible in high-risk patients with severe acute necrotising pancreatitis, a minimal access approach for drainage combined with a necrosectomy, either via an operative (ie, laparoscopic like) or an endoscopic transgastric or transduodenal approach, decreases mortality of this horrible disease when compared with the classic open operation (laparotomy). These data are convincing and support the use of such minimal access approaches whenever feasible. This study reviews the data on another huge advance in our treatment and understanding of this horrific disease.
In this commentary, I want to use this study as an example of the marked changes in our thinking of pancreatitis over the last 40 years. Our current approach to the treatment of necrotising pancreatitis really had its origin in the 1970s with the introduction of the new concept of an operative ‘necrosectomy’ rather than just peripancreatic drainage which at that time was designed to remove the bad humours believed to be the cause of the systemic aspects of the disease. Through the pioneering work of Beger and colleagues2 in Ulm, Germany and that of Bradley (and Stone) in Atlanta, Georgia, USA,3 a new era emerged with our thinking of this systemic inflammatory disease originating from endogenous pancreatic parenchymal necrosis and later, its superinfection. Indeed, the introduction of the importance of removing the infected necrotic tissues (necrosectomy) combined with drainage of the peripancreatic region immediately decreased the mortality of this disease …