Surgical tactics for gunshot wounds the pancreas

Abstract

The analysis of the results of treatment of 88 victims with gunshot wounds of the pancreas (pancreas) at the stages of providing qualified and specialized medical care in medical organizations of the Russian Ministry of Defense from 2023 to 2024 was carried out. In 76% of cases, combined wounds to the abdomen and other areas of the body were observed, isolated wounds in 24%, while injury only to the pancreas was noted in 3.4%, in all other cases (96.4%) simultaneously with the pancreas, there were injuries to other organs of the abdominal cavity. A feature of pancreatic gunshot wounds is the early (immediately after the injury) infection of the damaged organ with the development of acute traumatic pancreatitis (OTP) by 3–5 days with purulent complications characteristic of it, which occurred in 64,8% of cases. In order to prevent the development of complications, drug and surgical prophylaxis were performed. The essence of the latter was to observe the principle of minimal activity in relation to the pancreatic tissue, maximum activity in relation to drainage of the injury zone. The best results were obtained with the use of VAC drainage of parapancreatic and retroperitoneal tissue, which provided effective removal of pancreatic and purulent (with the development of phlegmon and abscess) secreted and lysing necrotic tissues. As a result of the treatment tactics used, the mortality rate for pancreatic gunshot wounds decreased from 28.6% in the first follow-up period to 15.2% in the second, with a total mortality rate of 21.6%.