OUTCOMES OF MINIMALLY INVASIVE INTERVENTIONS FOR SEVERE ACUTE PANCREATITIS DEPENDING ON SURGICAL TIMING AND TECHNIQUE IN A CENTRAL ASIAN COHORT

Abstract

Despite broad acceptance of the step-up approach for necrotising pancreatitis, the precise timing of minimally invasive intervention and the criteria for selecting between ultrasound-guided percutaneous drainage (PTBD), video-assisted retroperitoneal necrosectomy (VARD) and open necrosectomy remain subjects of ongoing debate. The 2019 WSES guidelines [1] recommend deferring intervention beyond 12 days when feasible, yet this guidance is largely based on cohorts from high-resource settings where CT-guided follow-up is readily available. In Central Asian emergency centres, late hospital presentation and limited imaging availability frequently make a prolonged conservative phase impractical. Moreover, published data on conversion rates and complication profiles by intervention type are almost exclusively derived from European and North American series, leaving a significant evidence gap for our region [2]. A critical unanswered question is whether the benefit of earlier intervention - guided by molecular-genetic risk stratification rather than clinical deterioration alone - outweighs the theoretical risk of operating on immature necrosis.